Neurologic Manifestations of Long COVID Affect Adult Females More Severely Than Males, 2026, Kopinsky et al.

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Neurologic Manifestations of Long COVID Affect Adult Females More Severely Than Males

Kopinsky, Hannah; Lopez, Melissa; Miller, Janet; Jimenez, Millenia; Liotta, Eric M.; Koralnik, Igor J.

ABSTRACT​

Objective​

To characterize differences in neurologic manifestations of postacute sequelae of SARS-CoV-2 infection (Neuro-PASC) between females and males.

Methods​

Cross-sectional study of the first consecutive 261 posthospitalization Neuro-PASC (PNP) and 2068 nonhospitalized Neuro-PASC (NNP) patients evaluated at the Neuro-COVID clinic between May 2020 and August 2025. Patients were classified based on biological sex.

Results​

There were more females than males in PNP (56.3% vs. 43.7%; p = 0.004) and NNP patients (66.3% vs. 33.7%; p < 0.0001).
An average of 16 months after symptom onset, females from both groups more frequently reported ≥ 4 neurologic symptoms than males (PNP: 79.6% vs. 64.9%; p = 0.007. NNP: 76.1% vs. 64.6%; p < 0.0001).
Both PNP and NNP females reported more frequently numbness/tingling, dizziness, headache and pain than males, while only NNP females reported more frequently brain fog, myalgias, dysgeusia and anosmia than NNP males.
In addition, females in both groups more frequently reported fatigue, shortness of breath, chest pain and dysautonomia compared to males, while only NNP females reported more frequent gastrointestinal symptoms than NNP male patients.
Compared to males, females from both groups reported worse fatigue on the patient-reported outcome measure information system (PROMIS) questionnaire, and NNP females had worse results in a task of attention on NIH Toolbox cognitive test.

Interpretation​

Females suffer from a higher symptom burden of Neuro-PASC and had worse subjective quality of life and objective cognitive function.
These results highlight the importance of timely diagnosis and targeted interventions in female patients who are often negatively affected by gender bias in medicine.

Web | DOI | PDF | Annals of Clinical and Translational Neurology
 
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