Front. Neural: Neurological Involvement in COVID-19 Among Non-Hospitalized Adolescents and Young Adults - Wyller et al - 2022

Introduction: Coronavirus disease 2019 (COVID-19) is prevalent among young people, and neurological involvement has been reported. We investigated neurological symptoms, cognitive test results, and biomarkers of brain injury, as well as associations between these variables in non-hospitalized adolescents and young adults with COVID-19.

Methods: This study reports baseline findings from an ongoing observational cohort study of COVID-19 cases and non-COVID controls aged 12–25 years (Clinical Trials ID: NCT04686734). Symptoms were charted using a standardized questionnaire. Cognitive performance was evaluated by applying tests of working memory, verbal learning, delayed recall, and recognition. The brain injury biomarkers, neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAp), were assayed in serum samples using ultrasensitive immunoassays.

Results: A total of 405 COVID-19 cases and 111 non-COVID cases were prospectively included. Serum Nfl and GFAp concentrations were significantly elevated in COVID-19 cases as compared with non-COVID controls (p = 0.050 and p = 0.014, respectively). The COVID-19 cases reported more fatigue (p< 0.001) and post-exertional malaise (PEM) (p = 0.001) compared to non-COVID-19 controls. Cognitive test performance and clinical neurological examination did not differ across the two groups. Within the COVID-19 group, there were no associations between symptoms, cognitive test results, and NfL or GFAp levels. However, fatigue and PEM were strongly associated with older age and female sex.

Conclusions: Non-hospitalized adolescents and young adults with COVID-19 reported more fatigue and PEM and had slightly elevated levels of brain injury markers, but showed normal cognitive performance. No associations were found between symptoms, brain injury markers, and cognitive test results, but fatigue and PEM were strongly related to female sex and older age.

https://www.frontiersin.org/articles/10.3389/fneur.2022.915712/full

 

"Questionnaires

The questionnaire contained questions on demographic background information and symptoms during the disease episode. In general, the frequency of specific symptoms was scored on five-point Likert scales (1–5) ranging from never to each day/always. Information on sex and ethnicity was self-reported. In addition, results from the following validated instruments are reported in the current paper:

Chalder Fatigue questionnaire (CFQ) addresses symptoms of mental and physical fatigue. The 11-item version used in this study has been validated as an assessment tool of chronic fatigue syndrome (39). Each item was scored on a four-point Likert scale (0–3), and CFQ was reported with a total range of 0–33.

Five items from DePaul Symptom Questionnaire (40) were used to address post-exertional malaise (PEM). The frequency of symptoms was rated on a five-point Likert scale, each item scored 0–4, ranging from never to each day/always. Scoring across all items was averaged and then multiplied with 25 to obtain a 0–100 scoring range.

Sleep-related problems were assessed using 12 items from the Karolinska Sleep Questionnaire (KSQ) (41), each item scored on a six-point Likert scale. Results were reported as the average score of all items ranging from 1 to 6 (lower scores correspond to more symptoms), as well as sub-scores for insomnia, awakening problems, and sleepiness.

Brief pain inventory (BPI) (42) is a four-item tool scoring pain from no pain to worst pain ever on a ten-point Likert scale. Results are reported as a summary score (ranging from 4–40) as well as the scores on each item."

 

Followed up with Neurological involvement among non-hospitalized adolescents and young adults 6 months after acute COVID-19 (2024, Frontiers in Neurology)