Long-term neurological manifestations of COVID-19: prevalence and predictive factors

  1. Andrea Pilotto
  2. Viviana Cristillo
  3. Stefano Cotti Piccinelli
  4. Nicola Zoppi
  5. Giulio Bonzi
  6. Davide Sattin
  7. Silvia Schiavolin
  8. Alberto Raggi
  9. Antonio Canale
  10. Stefano Gipponi
  11. Ilenia Libri
  12. Martina Frigerio
  13. Michela Bezzi
  14. Matilde Leonardi
  15. Alessandro Padovani

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Abstract

Background

Clinical investigations have argued for long-term neurological manifestations in both hospitalised and non-hospitalised COVID-19 patients. It is unclear whether long-term neurological symptoms and features depend on COVID-19 severity.

Methods

From a sample of 208 consecutive non-neurological patients hospitalised for COVID-19 disease, 165 survivors were re-assessed at 6 months according to a structured standardised clinical protocol. Prevalence and predictors of long-term neurological manifestations were evaluated using multivariate logistic regression analyses.

Results

At 6-month follow-up after hospitalisation due to COVID-19 disease, patients displayed a wide array of symptoms; fatigue (34%), memory/attention (31%) and sleep disorders (30%) were the most frequent. At neurological examination, 40% of patients exhibited neurological abnormalities, such as hyposmia (18.0%), cognitive deficits (17.5%), postural tremor (13.8%) and subtle motor/sensory deficits (7.6%). Older age, premorbid comorbidities and severity of COVID-19 were independent predictors of neurological manifestations in logistic regression analyses.

Conclusions

Premorbid vulnerability and severity of SARS-CoV-2 infection impact on prevalence and severity of long-term neurological manifestations.

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  1. Version published to 10.1007/s10072-021-05586-4
  2. Version published to 10.1101/2020.12.27.20248903v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.12.27.20248903: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the local ethics committee of ASST “Spedali Civili di Brescia” Hospital and the requirement for informed consent was waived by the Ethics Commission (NP 4166).
    Consent: The study was approved by the local ethics committee of ASST “Spedali Civili di Brescia” Hospital and the requirement for informed consent was waived by the Ethics Commission (NP 4166).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations should also be acknowledged. First, pre-morbid conditions were based on medical records and assessment during hospitalisation thus not allowing an extensive neurological and psychiatric screening at the baseline. Second, in this study patients with neurological diseases developed during the acute phase of SARS-CoV-2 infection were not considered, thus potentially underestimate the global neurological burden due to COVID-19. Furthermore, this is a single-center study with a relatively small sample size and large studies including non-hospitalized patients are warranted to confirm the present data. Limitations notwithstanding, our findings indicate that several neurological features are a relevant component of long-term manifestations of COVID-19 disease even in less severe patients, thus suggesting the importance of long-term follow-up programs to properly care patients and to be able to evaluate the real impact of SARS-CoV-2 infection on brain health status that is still uncertain15.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2020.12.27.20248903v1 on medRxiv