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. 2022 Jun;29(6):1685-1696.
doi: 10.1111/ene.15307. Epub 2022 Mar 23.

Neurological outcomes 1 year after COVID-19 diagnosis: A prospective longitudinal cohort study

Verena Rass  1 , Ronny Beer  1 , Alois Josef Schiefecker  1 , Anna Lindner  1 , Mario Kofler  1 , Bogdan Andrei Ianosi  1 , Philipp Mahlknecht  1 , Beatrice Heim  1 , Marina Peball  1 , Federico Carbone  1 , Victoria Limmert  1 , Philipp Kindl  1 , Lauma Putnina  1 , Elena Fava  1 , Sabina Sahanic  2 , Thomas Sonnweber  2 , Wolfgang N Löscher  1 , Julia V Wanschitz  1 , Laura Zamarian  1 , Atbin Djamshidian  1 , Ivan Tancevski  2 , Günter Weiss  2 , Rosa Bellmann-Weiler  2 , Stefan Kiechl  1 , Klaus Seppi  1 , Judith Loeffler-Ragg  2 , Bettina Pfausler  1 , Raimund Helbok  1
Affiliations

Neurological outcomes 1 year after COVID-19 diagnosis: A prospective longitudinal cohort study

Verena Rass et al. Eur J Neurol. 2022 Jun.

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.

Keywords: COVID-19; SARS-CoV-2; long COVID; neurological manifestations.

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Conflict of interest statement

KS reports grants from FWF Austrian Science Fund, grants from Michael J. Fox Foundation, grants from International Parkinson and Movement Disorder Society, personal fees from Teva, personal fees from UCB, personal fees from Lundbeck, personal fees from AOP Orphan Pharmaceuticals AG, personal fees from Abbvie, personal fees from Roche, personal fees from Grünenthal; all outside the submitted work. PM reports grants from TWF (Tyrolean Science Fund), grants from Medtronic, 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 sequelae 3 months and 1 year after being diagnosed with COVID‐19. SS‐16, 16‐item Sniffin' Sticks identification test; MoCA, Montreal Cognitive Assessment; PCL‐5, Post‐traumatic Stress Disorder Checklist; HADS, Hospital Anxiety and Depression Scale [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Self‐reported symptoms quantified based on the duration (any time, >4 weeks, >3 months, ≥1 year) [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Factors associated with (a) objective hyposmia (SS‐16 <13), (b) impaired cognition, MoCA <26, (c) signs of anxiety or depression, and (d) fatigue, FAS >21, with calculated adjusted odds ratios based on logistic regression with the 95% confidence intervals. MoCA, Montreal Cognitive Assessment; FAS, Fatigue Assessment Scale; SS‐16, 16‐item Sniffin' Sticks test
See this image and copyright information in PMC

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