Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”, 2021, Graham et al

Objective
Most SARS‐CoV‐2‐infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non‐hospitalized Covid‐19 “long haulers”.

Methods
This is a prospective study of the first 100 consecutive patients (50 SARS‐CoV‐2 laboratory‐positive and 50 laboratory‐negative individuals) presenting to our Neuro‐Covid‐19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid‐19, were never hospitalized for pneumonia or hypoxemia and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient‐reported quality of life measures and standardized cognitive assessments.

Results
Mean age was 43.2±11.3 years, 70% were female and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: “brain fog” (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), myalgias (55%), with only anosmia being more frequent in SARS‐CoV‐2+ than SARS‐CoV‐2‐ patients (37/50 [74%] vs (18/50 [36%]; p <0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS‐CoV‐2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic‐matched US population (T‐score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p<0.01).

Interpretation
Non‐hospitalized Covid‐19 “long haulers” experience prominent and persistent “brain fog” and fatigue that affect their cognition and quality of life.


Peer-reviewed pre-print (just needs copy-editing): https://onlinelibrary.wiley.com/doi/10.1002/acn3.51350

 

This study is getting a lot of news coverage in the US. It appears relatively good, but still missing some pieces. They appear hesitant about autonomic dysfunction and clearly label it all under "anxiety". There is only one mention of dysautonomia and it seems to acknowledge this gap in their understanding.

There is a section on similarities with ME:

However there is also this eye-rolling part:

 

Loosely related because the interview was about this study, but Putrino has been one of the first researchers working on this so useful on its own:

https://twitter.com/user/status/1374506540594466816


Otherwise I have seen articles and TV reports from many major news organizations. The apparent relevance of number of early neurological symptoms as a predictor of long-term symptoms is starting to sink in.

Getting close to the day where medicine discovers that neurological diseases have neurological symptoms. Maybe.

 

Studies like this one do not answer many questions. Still waiting for the first decent epidemiological study that shows that COVID-19 leads to increased disability and/or ME/CFS compared to a control group.