Mental and Physical Health in Wilson Disease Patients With SARS-CoV-2 Infection and Relevance of Long-COVID

Abstract

SARS-CoV-2 infection and Long COVID (LC) might lead to a significant deterioration of physical and mental health. Wilson disease (WD) patients have a chronic liver and/or neuropsychiatric disease, making it particularly interesting to investigate LC in WD. 51 WD patients were retrospectively examined, evaluating physical and mental health by a survey and neuropsychological tests (SF-12, PSQI, ISI, Epworth, Chalder-fatigue scale, PHQ-9, GAD-7, PSS, FLei) before and ~11 months after SARS-CoV-2 infection. LC was defined as the development of new, at least moderately severe symptoms (shortness of breath, chest pain, fatigue, brain fog, exercise capacity, concentration disturbances) and/or worsening of pre-existing symptoms. 70.6% had predominant hepatic and 29.4% had neuropsychiatric symptoms at WD diagnosis. Median age was 39 years; 56.1% were female. Patients were in stable maintenance phase with a median treatment duration of 23 years. When compared to before COVID-19, WD patients had significantly worse physical life quality, sleeping quality, and fatigue. After COVID-19, a high percentage of WD patients reported concentration disorders (60%), fatigue (55%), reduced exercise capacity (50%), shortness of breath (40%), chest pain (20%) and feeling of brain fog (15%). 39.2% (n = 20) of the WD patients were classified as LC. This LC-WD subgroup showed significantly impaired quality of life, a high stress level, and sleeping disturbances, fatigue, depression, anxiety, and cognitive impairment. A large proportion of WD patients experience LC symptoms, reduced life quality, and sleeping disorders after SARS-CoV-2 infection. WD patients post-infection should be well monitored and supported if they develop persisting symptoms or neuro-psychological problems.

Keywords: COVID‐19; SARS‐CoV‐2 infection; Wilson disease; long COVID; mental health; quality of life.

FIGURE 1

Inclusion criteria.

FIGURE 2

Summary of symptoms before and after SARS‐CoV‐2 infection (%). Before COVID‐19 infection. After COVID‐19 infection. Depicted are symptom frequencies [%] in Wilson disease patients before SARS‐CoV‐2 infection (in retrospect) and at the timepoint the symptom questionnaire was carried out. Symptoms are as follows: 1 Cough, 2 Fever, 3 Shortness of breath (unspecified), 3a Shortness of breath at rest, 3b Shortness of breath at mild activity, 3c Shortness of breath at extended activity, 4 Palpitation, 5 Chest pain (unspecified), 5a Chest pain at rest, 5b Chest pain at extended activity, 6 Fatigue, 7 Myalgia, 8 Arthralgia, 9 Muscular weakness, 10 Cephalgia, 11 Vertigo, 12 Feeling of “brain fog”, 13 Anxiety, 14 Depression, 15 Sleep disturbances (unspecified), 15a Sleep disturbances in falling asleep, 15b Sleep disturbances in sleeping through the night, 16 Stool abnormalities (unspecified), 16a Diarrhea, 16b Constipation, 17 Dysgeusia, 18 Dysosmia, 19 Alopecia, 20 Sore throat, 21 Rhinitis, 22 Reduced physical exercise capacity, 23 Blood pressure variations, 24 Concentration disturbances, 25 Amnestic dysphasia, 26 Memory disturbances.

FIGURE 3

(a–g) Results of neuropsychological tests before and after SARS‐CoV‐2 infection. (a) Quality of Life SF‐12 (PCS‐12 and MCS‐12). (b) Sleeping disturbances (PSQI, ISI and Epworth). (c) Fatigue symptoms (Chalder fatigue scale). (d) Depressive symptoms (PHQ‐9). (e) Anxiety (GAD‐7). (f) Stress level (PSS). (g) Cognitive complaints (FLei). (a–g) Shows the different neuropsychological scores before and after SARS‐CoV‐2 infection. The y‐axis shows the respective absolute value of the applied clinical score. The x‐axis plots the responses of the respective cohorts (total cohort, recovered cohort and Long‐COVID cohort) before and after SARS‐CoV‐2 infection as box‐plots.