Most people who had long neurological symptoms of COVID continued to have them for at least 6 months, pilot data from a prospective study showed.
Of 27 individuals with post-acute neurological sequelae of SARS-CoV-2 (PASC) infection in the NeuCOVID cohort, memory impairment and decreased concentration were the most prevalent symptoms at 6 months, reported Jacqueline Shanley, BA, and Jennifer Graves, MD, PhD, both of the University of California San Diego School of Medicine, and co-authors, in Annals of Clinical and Translational Neurology.
A third of patients had complete symptom resolution at 6 months, the researchers said. None of the people with persistent symptoms at 6 months had a history of pre-existing neurological disorders before their infection with SARS-CoV-2.
About 7% of the patients showed signs of a new phenotype, which the researchers called post-acute sequelae of COVID-19 infection with tremors, ataxia and cognitive deficit (PASC-TAC).
“These are people who didn’t have neurological issues before COVID-19, and now they have incoordination of their bodies and possible incoordination of their thoughts,” Graves said in a statement. “We didn’t expect to find this, so we want to spread the word in case other doctors see this too.”
It is likely that the neurological symptoms seen in this study are caused by the infection triggering an inflammatory autoimmune response in the brain, Graves observed.
Previous research has suggested that a over-stimulated immune system may be the cause of persistent post-COVID cognitive changes. Other reports have identified damage from thinning and leaking blood vessels in brain tissue samples from people who died with COVID, but found no evidence of a direct viral attack on the brain.
Graves and co-authors enrolled 56 people in their single-center study from October 2020 to October 2021. Patients had either PCR-confirmed infection or probable COVID-19 infection confirmed by evaluation at an infectious disease clinic.
Participants were assessed at a baseline visit and 6 months later. All had neurological symptoms after SARS-CoV-2 infection; a subset of 16 people had a pre-existing neurological condition such as multiple sclerosis.
The average age was 50 and most of the participants (69%) were women. The severity of infection was mostly mild (39.3%) or moderate (42.9%).
At baseline, after an acute infection, the most common neurological symptoms were fatigue (89.3%) and headache (80.4%). Other symptoms included memory impairment, insomnia and decreased concentration.
A total of 27 people completed the 6-month follow-up visit. Memory problems (68.8%) and decreased concentration (61.5%) were then the most important persistent symptoms. On average, all symptoms had lower severity scores at follow-up.
At 6 months, one-third of participants reported complete resolution of symptoms. From baseline to 6 months, mean scores on the Montreal Cognitive Assessment (MoCA) improved overall, but 26.3% of participants’ scores declined. The most affected cognitive domains were delayed recall, language, and attention.
“It’s encouraging that most people were showing some improvement at 6 months, but that wasn’t the case for everyone,” Graves said.
“Some of these participants are high-level professionals who are expected to score above average on cognitive assessments, but months after having COVID-19 they are still scoring abnormally high” , she pointed out.
Four long-term COVID patients without prior neurological disease demonstrated uncoordinated movements associated with cognitive dysfunction (PASC-TAC). Imaging in these patients appeared normal. These people had slow recovery and some symptoms required medication and supportive management beyond 6 months, Graves and colleagues noted.
Six participants presented with cranial nerve dysfunction, including two people with a history of neurological disease.
The researchers plan to track symptoms in the NeuCOVID study every year for 10 years. “For people’s cognition and quality of life to still be affected so long after infection, that’s something we as a society need to seriously look at,” Graves said.
“We still need to know how common this is, what biological processes cause it, and what ongoing health care these people will need,” she added. “This work is an important first step in getting there.”
Graves reported relationships with the National MS Society, Biogen, Octave Biosciences, Novartis, Sanofi-Genzyme, Alexion, Bristol Myers Squibb and Genentech. The co-authors reported relationships with the NIH.
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