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. 2025 Apr;46(4):1477-1488.
doi: 10.1007/s10072-025-08031-y. Epub 2025 Feb 14.

Neurologic features in hospitalized patients with COVID-19: a prospective cohort in a catalan hospital

Oriol Barrachina-Esteve  1   2 , A Anguita  3   4 , A Reverter  3 , J Espinosa  3 , C Lafuente  3 , M Rubio-Roy  3 , M Crosas  3 , C Vila-Sala  3 , C Acero  5 , M Navarro  6 , D Cánovas  3 , G Ribera  3 , M Jodar  3   7   8 , J Estela  3
Affiliations

Neurologic features in hospitalized patients with COVID-19: a prospective cohort in a catalan hospital

Oriol Barrachina-Esteve et al. Neurol Sci. 2025 Apr.

Abstract

Objectives: To study the prevalence and timing of neurological manifestations, including cognitive involvement, in patients hospitalized for Coronavirus disease 2019 (COVID-19). To analyze the pathogenic mechanisms and any association they have with disease severity.

Methods: Longitudinal cohort study with prospective follow-up of patients who required hospitalization. Patients under 65 who had no pre-existing cognitive impairment and did not require an ICU stay were evaluated 3 and 12 months after discharge using a battery of neuropsychological tests.

Results: Of 205 patients hospitalized for COVID-19, 153 (74.6%) presented with neurological manifestations. The most frequent were myalgia (32.7%), headache (31.7%), dysgeusia (29.2%), and anosmia (24.9%). Patients with more severe illness at the time of hospitalization presented fewer neurological manifestations. Of the 62 patients who underwent neuropsychological examination 3 months after discharge, 22.6% had impaired attention, 19.4% impaired working memory, 16.1% impaired learning and retrieval, 9.7% impaired executive functions, and 8.2% impaired processing speed. Patients with anosmia also presented with more headache (OR 5.45; p < 0.001) and greater risk of working memory impairment (OR 5.87; p 0.03). At follow-up 12 months after hospital discharge, 14.3% of patients still showed impaired attention, 2.4% impaired working memory, 2.5% impaired executive functions, and 2.5% impaired processing speed.

Discussion: Neurological manifestations are common in patients hospitalized for COVID-19 regardless of severity. The high prevalence of anosmia and its association with headache and working memory impairment at 3 months, suggest potential direct or indirect damage to the prefrontal cortex via invasion of the olfactory bulb by COVID-19.

Keywords: COVID-19; Clinical neurology; Cognitive disorders; Neurovirology.

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Conflict of interest statement

Declarations. Ethicals approval: The study was approved by the hospital’s ethics committee. Consent informed: Consent was obtained from all study participants before a witness given the circumstances of patient isolation and virus infectivity. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Brain MRI (a) DWI sequence: Multiple focal images predominantly periventricular and in both bilateral semioval centers, some of which present with restricted diffusion (not seen but they are hyperintense on T2/FLAIR and hypointense on T1) (b) SWI sequence: Hypointense punctiform foci that suggest microhemorrhages diffusely distributed in both supratentorial and infratentorial regions (cerebellar hemispheres and pons), in the corpus callosum and basal ganglia
Fig. 2
Fig. 2
Frequency of cognitive domains impairment at 3 and 12 months
Fig. 3
Fig. 3
Frequency of affective symptoms at 3 and 12 months
See this image and copyright information in PMC

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