Analysis of the National Institutes of Health COVID-19 Neuro Databank by geographic region and income status

Background While COVID-19 is more commonly known to present and persist in terms of respiratory symptoms, evidence for neurologic manifestations is limited. Objectives This study aims to provide an epidemiological overview of neurologic manifestations of COVID-19. It compares the demographic and clinical profiles of patients based on geographic location and country income classification. Moreover, it describes the neurologic manifestations of Long COVID. Methods This was a cross-sectional analysis of a multi-country cohort of patients with COVID-19-associated neurologic symptoms enrolled in the COVID-19 Neuro Databank from January 2020 to February 2025. Demographic, clinical and health system-related factors were described. Comparisons among geographic regions and income classifications were performed via analysis of variance and chi-square tests or Fisher’s exact tests. Results Majority of the 3,901 patients were from the United States (U.S.) and from high-income countries. The mean age was 57.27±18 years and 54% were males. Neurologic comorbidities were highest in the U.S. whereas non-neurologic comorbidities. Asia had the greatest frequency of severe COVID and mortality. Vaccination and use of COVID-19 medication was lowest in Africa. There were significant associations between COVID-19 vaccination and use of COVID-19 medications with income level. The five leading COVID-19-associated neurologic conditions were neurocognitive disorders, fatigue, headache, anosmia, and ageusia. A subset of Long COVID was identified as thought disorders, fatigue, mood disorders, stroke, headache, and neurocognitive disorders. Conclusions This study provides insight into the varying profile and burdens of COVID-19 associated neurologic conditions and the health inequities during the pandemic among geographic and income groups.