Evolution of neurologic symptoms in non-hospitalized COVID-19 "long haulers"

Abstract

Objective: We characterized the evolution of neurologic symptoms and self-perceived recovery of non-hospitalized COVID-19 "long haulers" 6-9 months after their initial Neuro-COVID-19 clinic evaluation.

Methods: In this follow-up study on the first 100 patients, 50 SARS-CoV-2 laboratory-positive (SARS-CoV-2⁺ ), and 50 laboratory-negative (SARS-CoV-2^- ), evaluated at our Neuro-COVID-19 clinic between May and November 2020, patients completed phone questionnaires on their neurologic symptoms, subjective impression of recovery and quality of life.

Results: Of 52 patients who completed the study (27 SARS-CoV-2⁺ , 25 SARS-CoV-2^- ) a median 14.8 (range 11-18) months after symptom onset, mean age was 42.8 years, 73% were female, and 77% were vaccinated for SARS-CoV-2. Overall, there was no significant change in the frequency of most neurologic symptoms between first and follow-up evaluations, including "brain fog" (81 vs. 71%), numbness/tingling (69 vs. 65%), headache (67 vs. 54%), dizziness (50 vs. 54%), blurred vision (34 vs. 44%), tinnitus (33 vs. 42%), and fatigue (87 vs. 81%). However, dysgeusia and anosmia decreased overall (63 vs. 27%, 58 vs. 21%, both p < 0.001). Conversely, heart rate and blood pressure variation (35 vs. 56%, p = 0.01) and gastrointestinal symptoms (27 vs. 48%, p = 0.04) increased at follow-up. Patients reported improvements in their recovery, cognitive function, and fatigue, but quality of life measures remained lower than the US normative population (p < 0.001). SARS-CoV-2 vaccination did not have a positive or detrimental impact on cognitive function or fatigue.

Interpretation: Non-hospitalized COVID-19 "long haulers" continue to experience neurologic symptoms, fatigue, and compromised quality of life 14.8 months after initial infection.

Figure 1

Subjective impression of percent recovery from pre‐COVID‐19 baseline at first clinic visit (circles) and follow‐up (triangles) relative to time from COVID‐19 symptom onset, displayed by SARS‐CoV‐2 status. Each subject is represented by a pair of connected points, with overlapping time points and percent recoveries illustrated by increased point opacity. Only subjects with paired responses from the initial clinic visit and follow‐up survey are represented in the Figure. A pre‐COVID‐19 baseline of 100% was assumed. p values <0.05 are indicated in bold in the table.

Figure 2

PROMIS Quality of Life domain scores for cognitive function and fatigue, by SARS‐CoV‐2 result. (A) T‐scores from the first clinic visit (circles) and follow‐up (triangles) are displayed against respective boxplots (outliers displayed as solid circles), grouped by SARS‐CoV‐2 status. Only subjects with T‐scores from both the initial clinic visit and follow‐up are displayed. (B) Differences between first visit and follow‐up T‐scores were compared by SARS‐CoV‐2 status with paired analyses, while changes in T‐scores across paired timepoints in individual patients were compared between SARS‐CoV‐2 groups with unpaired analyses. p values <0.05 are indicated in bold in the table.