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. 2022 Sep;31(3):e1914.
doi: 10.1002/mpr.1914. Epub 2022 Jun 15.

New-onset and persistent neurological and psychiatric sequelae of COVID-19 compared to influenza: A retrospective cohort study in a large New York City healthcare network

Andrei L Iosifescu  1 , Wouter S Hoogenboom  1 , Alexandra J Buczek  1 , Roman Fleysher  1 , Tim Q Duong  1
Affiliations

New-onset and persistent neurological and psychiatric sequelae of COVID-19 compared to influenza: A retrospective cohort study in a large New York City healthcare network

Andrei L Iosifescu et al. Int J Methods Psychiatr Res. 2022 Sep.

Abstract

Objectives: Neurological and neuropsychiatric manifestations of post-acute SARS-CoV-2 infection (neuro-PASC) are common among COVID-19 survivors, but it is unknown how neuro-PASC differs from influenza-related neuro-sequelae. This study investigated the clinical characteristics of COVID-19 patients with and without new-onset neuro-PASC, and of flu patients with similar symptoms.

Methods: We retrospectively screened 18,811 COVID-19 patients and 5772 flu patients between January 2020 and June 2021 for the presence of new-onset neuro-sequelae that persisted at least 2 weeks past the date of COVID-19 or flu diagnosis.

Results: We observed 388 COVID-19 patients with neuro-PASC versus 149 flu patients with neuro-sequelae. Common neuro-PASC symptoms were anxiety (30%), depression (27%), dizziness (22%), altered mental status (17%), chronic headaches (17%), and nausea (11%). The average time to neuro-PASC onset was 138 days, with hospitalized patients reporting earlier onset than non-hospitalized patients. Neuro-PASC was associated with female sex and older age (p < 0.05), but not race, ethnicity, most comorbidities, or COVID-19 disease severity (p > 0.05). Compared to flu patients, COVID-19 patients were older, exhibited higher incidence of altered mental status, developed symptoms more quickly, and were prescribed psychiatric drugs more often (p < 0.05).

Conclusions: This study provides additional insights into neuro-PASC risk factors and differentiates between post-COVID-19 and post-flu neuro-sequelae.

Keywords: COVID-19; influenza; neuropsychiatry; new-onset symptoms.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Inclusion/exclusion criteria for neuro‐PASC and control cohorts
FIGURE 2
FIGURE 2
Most prevalent neurological sequelae of COVID‐19 and flu. More COVID‐19 patients experienced altered mental status (AMS) than flu patients (p = 0.00014). No significant group differences were observed for any other symptoms
FIGURE 3
FIGURE 3
(a) Histogram of neuro‐PASC symptom onset timepoints as days from COVID‐19 diagnosis. Red dotted line = average time of symptom onset. (b) Patient hospitalization status versus days to symptom onset (p = 0.025). (c) Histogram of neuropsychiatric symptom onset timepoints as days from flu diagnosis
FIGURE 3
FIGURE 3
(a) Histogram of neuro‐PASC symptom onset timepoints as days from COVID‐19 diagnosis. Red dotted line = average time of symptom onset. (b) Patient hospitalization status versus days to symptom onset (p = 0.025). (c) Histogram of neuropsychiatric symptom onset timepoints as days from flu diagnosis
FIGURE 3
FIGURE 3
(a) Histogram of neuro‐PASC symptom onset timepoints as days from COVID‐19 diagnosis. Red dotted line = average time of symptom onset. (b) Patient hospitalization status versus days to symptom onset (p = 0.025). (c) Histogram of neuropsychiatric symptom onset timepoints as days from flu diagnosis
FIGURE 4
FIGURE 4
(a) Most prescribed neuropsychiatric drugs post‐COVID‐19. (b) Patient hospitalization status versus number of prescribed drugs (p < 0.0001)
FIGURE 4
FIGURE 4
(a) Most prescribed neuropsychiatric drugs post‐COVID‐19. (b) Patient hospitalization status versus number of prescribed drugs (p < 0.0001)
See this image and copyright information in PMC

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