Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment, July 2023, Bestecher et al

Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment

Abstract
As the heterogeneity of symptoms is increasingly recognized among long-COVID patients, it appears highly relevant to study potential pathophysiological differences along the different subtypes. Preliminary evidence suggests distinct alterations in brain structure and systemic inflammatory patterns in specific groups of long-COVID patients. To this end, we analyzed differences in cortical thickness and peripheral immune signature between clinical subgroups based on 3T-MRI scans and signature inflammatory markers in n=120 participants comprising healthy never-infected controls, healthy COVID-19 survivors, and subgroups of long-COVID patients with and without cognitive impairment according to screening with Montreal Cognitive Assessment.

Whole-brain comparison of cortical thickness between the 4 groups was conducted by surface-based morphometry. We identified distinct cortical areas showing a progressive increase in cortical thickness across different groups, starting from healthy individuals who had never been infected with COVID-19, followed by healthy COVID-19 survivors, long-COVID patients without cognitive deficits (MoCA ≥ 26), and finally, long-COVID patients exhibiting significant cognitive deficits (MoCA < 26).

These findings highlight the continuum of cortical thickness alterations associated with COVID-19, with more pronounced changes observed in individuals experiencing cognitive impairment (p<0.05, FWE-corrected). Affected cortical regions covered prefrontal and temporal gyri, insula, posterior cingulate, parahippocampal gyrus, and parietal areas. Additionally, we discovered a distinct immunophenotype, with elevated levels of IL-10, IFNg, and sTREM2 in long-COVID patients, especially in the group suffering from cognitive impairment. We demonstrate lingering cortical and immunological alterations in healthy and impaired subgroups of COVID-19 survivors.

This implies a complex underlying pathomechanism in long-COVID and emphasizes the necessity to investigate the whole spectrum of post-COVID biology to determine targeted treatment strategies targeting specific sub-groups.


Preprint uploaded to medRvix: https://www.medrxiv.org/content/10.1101/2023.07.21.23292988v1

 

Papers I've seen discussing grey matter decrease or increase post Covid are —

Decreased
Covid-19 related cognitive, structural and functional brain changes among Italian adolescents and young adults: a multimodal longitudinal case-control study (2023, Preprint: MedRxiv)
Hippocampal subfield abnormalities and biomarkers of pathologic brain changes: from SARS-CoV-2 acute infection to post-COVID syndrome (2023, Lancet: eBioMedicine)
Multivariate prediction of long COVID headache in adolescents using gray matter structural MRI features (2023, Frontiers in Human Neuroscience)
Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 “long haulers” (2023, BMC Neurology)
SARS-CoV-2 is associated with changes in brain structure in UK Biobank (2022, Nature)

Increased
This preprint.
Larger gray matter volumes in neuropsychiatric long-COVID syndrome (2022, Psychiatry Research)

 

Published as —

Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment
Besteher; Rocktäschel; Garza; Machnik; Ballez; Helbing; Finke; Reuken; Güllmar; Gaser; Walter; Opel; Rita Dunay

As the heterogeneity of symptoms is increasingly recognized among long-COVID patients, it appears highly relevant to study potential pathophysiological differences along the different subtypes. Preliminary evidence suggests distinct alterations in brain structure and systemic inflammatory patterns in specific groups of long-COVID patients.

To this end, we analyzed differences in cortical thickness and peripheral immune signature between clinical subgroups based on 3T-MRI scans and signature inflammatory markers in n=120 participants comprising healthy never-infected controls (n=30), healthy COVID-19 survivors (n=29), and subgroups of long-COVID patients with (n=26) and without (n=35) cognitive impairment according to screening with Montreal Cognitive Assessment. Wholebrain comparison of cortical thickness between the 4 groups was conducted by surface-based morphometry.

We identified distinct cortical areas showing a progressive increase in cortical thickness across different groups, starting from healthy individuals who had never been infected with COVID-19, followed by healthy COVID-19 survivors, long-COVID patients without cognitive deficits (MoCA ≥ 26), and finally, long-COVID patients exhibiting significant cognitive deficits (MoCA < 26). These findings highlight the continuum of cortical thickness alterations associated with COVID-19, with more pronounced changes observed in individuals experiencing cognitive impairment (p<0.05, FWE-corrected). Affected cortical regions covered prefrontal and temporal gyri, insula, posterior cingulate, parahippocampal gyrus, and parietal areas. Additionally, we discovered a distinct immunophenotype, with elevated levels of IL-10, IFN, and sTREM2 in long-COVID patients, especially in the group suffering from cognitive impairment.

We demonstrate lingering cortical and immunological alterations in healthy and impaired subgroups of COVID-19 survivors. This implies a complex underlying pathomechanism in long-COVID and emphasizes the necessity to investigate the whole spectrum of post-COVID biology to determine targeted treatment strategies targeting specific sub-groups.

Link | PDF (Brain, Behavior, and Immunity)

 

how do the FND and functional cognitive disorder people respond to this?

 

Well it's all neuroplasticity of course.

In The neuroimaging evidence of brain abnormalities in functional movement disorders (2021, Brain) —

Referencing Gray matter differences in patients with functional movement disorders (2018, Neurology) —

Referencing Grey matter abnormalities in children and adolescents with functional neurological symptom disorder (2017, NeuroImage: Clinical) —

 

Probably much as I do - it is difficult to know what on earth it might mean. Thicker cortex usually means healthier. Maybe more intelligent people are more likely to report brain fog after Covid.

 

Good grief this is pure fanaticism. They define the whole thing as the absence of "structural" changes, therefore psychological, and when they find some they just attribute them to psychological processes, even in children, who didn't even live long enough for it to apply. The framing of vigilance makes no sense whatsoever, it's just belief support belief.