Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms

Abstract

Objective: To assess the initial features and evolution of neurologic Postacute Sequelae of SARS-CoV-2 infection (neuro-PASC) in patients with and without prior neurologic disease.

Methods: Participants with neurologic symptoms following acute SARS-CoV-2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a SARS-CoV-2 infection history, neurologic review of systems, neurologic exam, Montreal cognitive assessment (MoCA), and symptom-based self-reported surveys at baseline (conducted after acute infection) and 6-month follow-up assessments.

Results: Fifty-six participants (69% female, mean age 50 years, 29% with prior neurologic disease such as multiple sclerosis) were enrolled, of which 27 had completed the 6-month follow-up visit in this ongoing study. SARS-CoV-2 infection severity was largely described as mild (39.3%) or moderate (42.9%). At baseline, following acute infection, the most common neurologic symptoms were fatigue (89.3%) and headaches (80.4%). At the 6-month follow-up, memory impairment (68.8%) and decreased concentration (61.5%) were the most prevalent, though on average all symptoms showed a reduction in reported severity score at the follow-up. Complete symptom resolution was reported in 33.3% of participants by 6 months. From baseline to 6 months, average MoCA scores improved overall though 26.3% of participants' scores decreased. A syndrome consisting of tremor, ataxia, and cognitive dysfunction (PASC-TAC) was observed in 7.1% of patients.

Interpretation: Early in the neuro-PASC syndrome, fatigue and headache are the most commonly reported symptoms. At 6 months, memory impairment and decreased concentration were most prominent. Only one-third of participants had completed resolution of neuro-PASC at 6 months, although persistent symptoms trended toward improvement at follow-up.

Keywords: COVID-19; postacute sequelae of COVID-19 infection.

Figure 1

The number of participants reporting each neurologic symptom at the baseline visit, subcategorized by symptom history prior to COVID infection. “None prior” refers to the number of participants with baseline symptoms new since COVID infection; “Prior, worsened” refers to participants with baseline symptoms worse since COVID infection; “Prior, no change” refers to participants with baseline symptoms unchanged since COVID infection; “Unable to report severity” refers to participants who report the presence of symptoms at baseline visit but were unable to report severity, and therefore relative change could not be determined. Percentages represent the proportion of participants reporting each symptom out of total baseline participants (n = 56). [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2

Neurologic symptom persistence and change in severity by percentage at 6 months. For each symptom, the yellow bars represent the participants with symptom persistence at 6 months as a percentage of all participants with that symptom at baseline. The blue bars represent the average percent decrease in severity score (within individual participants) from baseline to 6 months for each symptom. The final bar labeled “Any Symptom” shows the percentage of participants reporting at least one persistent symptom at 6 months. [Colour figure can be viewed at wileyonlinelibrary.com]