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Observational Study
. 2021 Oct;28(10):3348-3359.
doi: 10.1111/ene.14803. Epub 2021 May 3.

Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study

Verena Rass  1 , Ronny Beer  1 , Alois Josef Schiefecker  1 , Mario Kofler  1 , Anna Lindner  1 , Philipp Mahlknecht  1 , Beatrice Heim  1 , Victoria Limmert  1 , Sabina Sahanic  2 , Alex Pizzini  2 , Thomas Sonnweber  2 , Ivan Tancevski  2 , Christoph Scherfler  1 , Laura Zamarian  1 , Rosa Bellmann-Weiler  2 , Günter Weiss  2 , Atbin Djamshidian  1 , Stefan Kiechl  1 , Klaus Seppi  1 , Judith Loeffler-Ragg  2 , Bettina Pfausler  1 , Raimund Helbok  1
Affiliations
Observational Study

Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study

Verena Rass et al. Eur J Neurol. 2021 Oct.

Abstract

Background and purpose: To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.

Methods: In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist-5) 3 months after disease onset.

Results: Of 135 consecutive COVID-19 patients, 31 (23%) required intensive care unit (ICU) care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient care (mild) during acute disease. At the 3-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included polyneuro/myopathy (n = 17, 13%) with one patient presenting with Guillain-Barré syndrome, mild encephalopathy (n = 2, 2%), parkinsonism (n = 1, 1%), orthostatic hypotension (n = 1, 1%), and ischemic stroke (n = 1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at the 3-month follow-up. Self-reported hyposmia/anosmia was lower (17%) at 3 months, however, improved when compared to the acute disease phase (44%; p < 0.001). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety, and posttraumatic stress disorders in 11%, 25%, and 11%, respectively.

Conclusions: Despite recovery from the acute infection, neurological symptoms were prevalent at the 3-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.

Keywords: COVID-19; SARS-CoV-2; neuro-COVID; neurologic manifestations; quality of life.

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Conflict of interest statement

K.S. reports grants from the FWF Austrian Science Fund, Michael J. Fox Foundation, and the International Parkinson and Movement Disorder Society; and personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, Abbvie, Roche, and Grünenthal; all outside the submitted work. P.M. reports grants from TWF (Tyrolean Science Fund) and Medtronic, and personal fees from Boston Scientific, all outside the submitted work. The other authors have nothing to disclose. All other authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Neurological diagnoses before COVID‐19 (red bars) and new‐onset diagnoses (blue bars) 3 months after COVID‐19 in 135 patients. CIP/CIM, critical illness polyneuropathy/critical illness myopathy [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Age distribution of neurological symptoms including frontal release signs, tremors, bradykinesia, and hyposmia as assessed with the 16‐item Sniffin’ Sticks test (SS‐16) in percentages [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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