Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity.
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Perez Giraldo Gina S, Ali Sareen T, Kang Anthony K, Patel Tulsi R, Budhiraja Shreya, Gaelen Jordan I, Lank Grace K, Clark Jeffrey R, Mukherjee Shreya, Singer Tracey, Venkatesh Aditi, Orban Zachary S, Lim Patrick H, Jimenez Millenia, Miller Janet, Taylor Carolyn, Szymanski April L, Scarpelli Jessica, Graham Edith L, Balabanov Roumen D, Barcelo Bianca E, Cahan Joshua G, Ruckman Kaitlyn, Shepard Alan G, Slutzky Marc W, LaFaver Kathrin, Kumthekar Priya U, Shetty Neil K, Carroll Katherine S, Ho Sam U, Lukas Rimas V, Batra Ayush, Liotta Eric M, Koralnik Igor J
Аннотация
METHODS: Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021.
RESULTS: PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients.
INTERPRETATION: PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.