Neurological outcomes 1 year after COVID‐19 diagnosis: A prospective longitudinal cohort study
Verena Rass, Ronny Beer, Alois Josef Schiefecker, Anna Lindner, Mario Kofler, Bogdan‐Andrei Ianosi, Philipp Mahlknecht, Beatrice Heim, Marina Peball, Federico Carbone, Victoria Limmert, Philipp Kindl, Lauma Putnina, Elena Fava, Sabina Sahanic, Thomas Sonnweber, Wolfgang N. Löscher, Julia Wanschitz, Laura Zamarian, Atbin Djamshidian, Ivan Tancevski, Günter Weiß, Rosa Bellmann‐Weiler, Stefan Kiechl, Klaus Seppi, Judith Löffler‐Ragg, Bettina Pfausler, Raimund Helbok
Abstract
BACKGROUND AND PURPOSE: Neurological sequelae from coronavirus disease 2019 (COVID-19) may persist after recovery from acute infection. Here, the aim was to describe the natural history of neurological manifestations over 1 year after COVID-19. METHODS: A prospective, multicentre, longitudinal cohort study in COVID-19 survivors was performed. At a 3-month and 1-year follow-up, patients were assessed for neurological impairments by a neurological examination and a standardized test battery including the assessment of hyposmia (16-item Sniffin' Sticks test), cognitive deficits (Montreal Cognitive Assessment < 26) and mental health (Hospital Anxiety and Depression Scale and Post-traumatic Stress Disorder Checklist 5). RESULTS: Eighty-one patients were evaluated 1 year after COVID-19, out of which 76 (94%) patients completed a 3-month and 1-year follow-up. Patients were 54 (47-64) years old and 59% were male. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year). Symptoms at 1-year follow-up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disturbances (22%), myalgia (17%), limb weakness (17%), headache (16%), impaired sensation (16%) and hyposmia (15%). Neurological examination revealed findings in 52/81 (64%) patients without improvement over time (3 months, 61%, p = 0.230) including objective hyposmia (Sniffin' Sticks test <13; 51%). Cognitive deficits were apparent in 18%, whereas signs of depression, anxiety and post-traumatic stress disorders were found in 6%, 29% and 10% respectively 1 year after infection. These mental and cognitive disorders had not improved after the 3-month follow-up (all p > 0.05). CONCLUSION: Our data indicate that a significant patient number still suffer from neurological sequelae including neuropsychiatric symptoms 1 year after COVID-19 calling for interdisciplinary management of these patients.