Comparative features and outcomes of major neurological complications of COVID-19.

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Abstract

The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations.

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Non-motor features of Parkinson disease

Anthony H. V. Schapira, K Chaudhuri, Peter Jenner (2017)

This corrects the article DOI: 10.1038/nrn.2017.62.

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Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis

Shin Yong (2021)

Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved. This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases. The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID. Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.

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Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Silvia Alonso-Lana, Marta Marquie, Agustín Ruiz … (2020)

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer’s field, triggering the implementation of telemedicine. COVID-19 survivors should be periodically evaluated with comprehensive cognitive and neuropsychiatric assessments, and specific mental health and cognitive rehabilitation programs should be provided for those suffering long-term cognitive and psychiatric sequelae.

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Author and article information

Journal

Journal ID (iso-abbrev): Eur J Neurol

Title: European journal of neurology

Publisher: Wiley

ISSN (Electronic): 1468-1331

ISSN (Print): 1351-5101

Publication date (Electronic): Feb 2023

Volume: 30

Issue: 2

Affiliations

[1 ] Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

[2 ] Centre Hospitalier Universitaire de Grenoble, Service de Neurologie, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble, France.

[3 ] Neurology Department, Colentina Clinical Hospital, Bucharest, Romania and Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

[4 ] Diomid Gherman Institute of Neurology and Neurosurgery, Chișinău, Moldova.

[5 ] Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

[6 ] Neurology Unit ASST Valcamonica, Brescia, Italy.

[7 ] University Clinic for Neurology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia.

[8 ] Department of the Research Centre of Neurology, Moscow, Russia.

[9 ] Semmelweis University Budapest, Budapest, Hungary.

[10 ] Tel Aviv University School of Medicine and Shamir (Assaf Harofeh) Medical Center, Tel Aviv, Israel.

[11 ] Department of Neurology, Specialist Hospital Konskie, Collegium Medicum, Jan Kochanowski University, Kielce, Poland.

[12 ] CEPID BRAINN - Brazilian Institute of Neuroscience and Neurotechnology and University of Campinas, Campinas, Brazil.

[13 ] Neurology Department Hospital Santo António - CHUP, Porto, Portugal.

[14 ] Department of Neurology, UHC Sestre milosrdnice, Zagreb, Croatia.

[15 ] Department of Neurology, Centro Hospitalar Universitário de São João, E.P.E, Porto, Spain.

[16 ] Cardiovascular I&D Unit, Portugal Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal.

[17 ] Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi. Hospital Central, San Luis Potosi, Mexico.

[18 ] Department of Neurology, Oslo University Hospital, Oslo, Norway.

[19 ] Department of Neurology and Neurosurgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.

[20 ] Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey.

[21 ] University of Health Science, Gulhane School of Medicine, Neurology Department, Ankara, Turkey.

[22 ] Department of Neurology, Kepler University Hospital, Linz, Austria.

[23 ] European Acadmey of Neurology, Vienna, Austria.

[24 ] Neurocritical Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

[25 ] Department of Neurology, University Hospital of Bern, Bern, Switzerland.

Article

DOI: 10.1111/ene.15617

PMC ID: 9874573

PubMed ID: 36314485

SO-VID: 34008d5b-4d29-43a6-9b97-e23ac536aaa1

History

Keywords: COVID-19,coronavirus,neurological complications,neurology

Data availability:

Keywords: COVID-19, coronavirus, neurological complications, neurology

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Comparative features and outcomes of major neurological complications of COVID-19.

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Most cited references 32

Non-motor features of Parkinson disease

Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

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