ABSTRACT
BACKGROUND: Long-term sequelae of COVID-19 can result in reduced functionality of the central nervous system and substandard quality of life. Gaining insight into the recovery trajectory of admitted COVID-19 patients on their cognitive performance and global structural brain connectivity may allow a better understanding of the diseases' relevance. OBJECTIVES: To assess whole-brain structural connectivity in former non-intensive-care unit (ICU)- and ICU-admitted COVID-19 survivors over 2 months following hospital discharge and correlate structural connectivity measures to cognitive performance. METHODS: Participants underwent Magnetic Resonance Imaging brain scans and a cognitive test battery after hospital discharge to evaluate structural connectivity and cognitive performance. Multilevel models were constructed for each graph measure and cognitive test, assessing the groups' influence, time since discharge, and interactions. Linear regression models estimated whether the graph measurements affected cognitive measures and whether they differed between ICU and non-ICU patients. RESULTS: Six former ICU and six non-ICU patients completed the study. Across the various graph measures, the characteristic path length decreased over time (ß = 0.97, p = 0.006). We detected no group-level effects (ß = 1.07, p = 0.442) nor interaction effects (ß = 1.02, p = 0.220). Cognitive performance improved for both non-ICU and ICU COVID-19 survivors on four out of seven cognitive tests 2 months later (p < 0.05). CONCLUSION: Adverse effects of COVID-19 on brain functioning and structure abate over time. These results should be supported by future research including larger sample sizes, matched control groups of healthy non-infected individuals, and more extended follow-up periods.
Subject(s)
COVID-19 , Humans , COVID-19/pathology , Quality of Life , Brain/pathology , Cognition , SurvivorsABSTRACT
Introduction: The 'coronavirus disease of 2019' (COVID-19) is an acute infection caused by the novel 'severe acute respiratory syndrome coronavirus-2' which has evolved into an ongoing pandemic with more than six million case fatalities to date. Evidence from large-scale observational studies has consistently shown that simply having MS does not make affected subjects more susceptible to contract COVID-19 nor to become severely ill from the infection, as compared to the general population. Risk factors are similar in both settings and include older age, male gender, cardiovascular comorbidities, African- American ethnicity, progressive disease and B-cell depleting agents. However, the reverse relationship - i.e., the impact of COVID-19 on clinical disability related to MS - remains less well described. Objective(s): To explore whether COVID-19 is associated with accelerated disability worsening in patients with MS. Method(s): Since March 2020, demographics and COVID-19 severity (categorized as ambulatory, hospitalized, death) of patients with MS have been collected at the Belgian National MS Center in Melsbroek in case of COVID-19 diagnosis (i.e., positive polymerase chain reaction test). On February 28, 2022, this database was locked and consisted of 234 unique cases. Clinical disability measures - including Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test, 9-Hole Peg Test and Symbol Digit Modalities Test scores - were available from a larger local database, obtained during routine medical follow-up. For each of these parameters, the first two assessments before COVID-19 diagnosis (labelled T0 and T1, respectively;T1 is the closest to COVID-19 diagnosis), and the first thereafter (labelled T2), were retrieved for every COVID-19 case. Result(s): Mortality and hospitalisation rate in this cohort was 5/234 (2.1%) and 37/234 (15.8%), respectively. Among the survivors with complete EDSS data (N = 139), mean annualized EDSS score changes between T1 and T2 (i.e., including the COVID-19 infection) were significantly increased, as compared with the respective changes between T0 and T1 (i.e., not including the COVID-19 infection) (0.09 versus 0.36, p = 0.008). Similar effects were not found for the other clinical outcome measures. Conclusion(s): COVID-19 infection is associated with global disability worsening in patients with MS. Our findings highlight the importance of preventive measures against COVID-19 spreading within this population.
ABSTRACT
Background: Classic health care (HC) models are currently being challenged by the 'coronavirus disease of 2019' (COVID-19) pandemic for which social isolation and unprecedented mobility restrictions have been deployed as essential measures of constrain. Digital communication services have the potential to preserve and improve access to specialized medical facilities in a cost- and time-efficient manner. Nonetheless, studies on live interaction between patients with multiple sclerosis (MS) and HC providers for neurological follow-up are still scarce. In a recent pilot project, we have shown that individual real-time audiovisual teleconsultations (TCs) over the internet are feasible and highly appreciated in patients with MS, but compliance and technical reliability over time remain to be demonstrated. Objectives: To evaluate feasibility of real-time audiovisual TCs over the internet for neurological follow-up of patients with MS. Methods: Thirty patients with MS presenting at a specialized center in Belgium were recruited for this ongoing study, and scheduled to receive 4 TCs over the course of 12 months. Patients were provided a unique hyperlink by mail in advance, leading them automatically and directly to the virtual waiting room, where they could accept or decline our incoming call. All TCs are performed by a trained HC professional with the intention to keep the conversation similar to what is usually discussed during a classic face-toface MS consultation. The approach will be considered feasible if at least 80% of the planned TCs can be successfully completed at the foreseen moment. We present the results of an interim analysis (July 8, 2020), when at least 2 TCs were executed in each participant. Patient satisfaction (technical quality, convenience, quality of care and added value) was evaluated via telephone by means of 5-point Likert scales containing the categories very unsatisfied, unsatisfied, neutral, satisfied and highly satisfied. Results: Three participants dropped out of the study due to loss of interest (2) or a broken device (1). Sixty of the 75 scheduled TCs were successfully completed (80%). Failures were due to patients not responding (7/56) or technical issues (8/56). Out of the 27 active participants, 24 responded to the telephone call for satisfaction analysis. Rates of patients declaring themselves satisfied or highly satisfied regarding the TCs were 19/24 for technical quality, 23/24 for convenience, 22/24 for quality of care and 21/24 for added value. Conclusions: Real-time audiovisual TCs over the internet appear to be feasible and well-received in patients with MS. Full completion of this trial is expected early next year. Incorporation of digital communication services in routine MS practice is expected to improve access to specialized care, particularly in dire times such as the current COVID-19 crisis.