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J Neural Transm (Vienna) ; 128(1): 37-48, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064510


Information about Parkinson's disease (PD) patients with severe COVID-19 is scarce. We aimed to analyze the clinical characteristics, outcomes, and risk factors affecting the prognosis of PD patients with severe COVID-19 infection. Clinical data of severe COVID-19 patients admitted at the Union Hospital, Wuhan between 28th January and 29th February 2020 were collected and analyzed. 10 patients (1.96%) had a medical history of PD with a mean (SD) age of 72.10 (± 11.46) years. The clinical characteristics and outcomes of severe COVID-19 with and without PD patients were then compared. There was no significant difference in overall mortality between the PD and non-PD patients with severe COVID-19 (p > 0.05). In PD patients with severe COVID-19, the proportion of patients with critical type, disturbance of consciousness, incidence of complications, white blood cells count and neutrophils counts on admission seem higher in the non-survivors. PD patients with older age, longer PD duration, and late stage PD may be highly susceptible to critical COVID-19 infection and bad outcome. The PD patients with consciousness disorders and complications that progressed rapidly are at increased risk of death.

COVID-19/epidemiology , Consciousness Disorders/epidemiology , Parkinson Disease/epidemiology , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , China/epidemiology , Comorbidity , Consciousness Disorders/etiology , Female , Humans , Male , Middle Aged , Parkinson Disease/mortality , Retrospective Studies , Risk Factors , Severity of Illness Index
Neurology ; 96(11): e1527-e1538, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1028513


OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.

COVID-19/mortality , Confusion/physiopathology , Consciousness Disorders/physiopathology , Hospital Mortality , Stroke/physiopathology , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/physiopathology , Anosmia/epidemiology , Anosmia/physiopathology , Ataxia/epidemiology , Ataxia/physiopathology , COVID-19/physiopathology , Confusion/epidemiology , Consciousness Disorders/epidemiology , Cranial Nerve Diseases/epidemiology , Cranial Nerve Diseases/physiopathology , Delirium/epidemiology , Delirium/physiopathology , Female , Headache/epidemiology , Headache/physiopathology , Humans , Male , Middle Aged , Paresthesia/epidemiology , Paresthesia/physiopathology , Primary Dysautonomias/epidemiology , Primary Dysautonomias/physiopathology , Recurrence , SARS-CoV-2 , Seizures/epidemiology , Seizures/physiopathology , Stroke/epidemiology , Vertigo/epidemiology , Vertigo/physiopathology
Neurotox Res ; 38(1): 1-7, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-244976


As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.

Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Nervous System Diseases/etiology , Pneumonia, Viral/complications , Angiotensin-Converting Enzyme 2 , COVID-19 , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/etiology , Combined Modality Therapy , Consciousness Disorders/epidemiology , Consciousness Disorders/etiology , Coronavirus Infections/psychology , Coronavirus Infections/virology , Dizziness/epidemiology , Dizziness/etiology , Encephalitis, Viral/epidemiology , Encephalitis, Viral/etiology , Endothelial Cells/metabolism , Endothelial Cells/virology , Fatigue/epidemiology , Fatigue/etiology , Headache/epidemiology , Headache/etiology , Humans , Intracranial Hypertension/epidemiology , Intracranial Hypertension/etiology , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/therapy , Mood Disorders/drug therapy , Mood Disorders/epidemiology , Mood Disorders/etiology , Mood Disorders/therapy , Nervous System Diseases/epidemiology , Neurons/metabolism , Neurons/virology , Olfactory Nerve/virology , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/psychology , Pneumonia, Viral/virology , Prevalence , Prognosis , Psychotherapy , Psychotropic Drugs/therapeutic use , Receptors, Virus/metabolism , Retrospective Studies , SARS-CoV-2 , Sensation Disorders/epidemiology , Sensation Disorders/etiology , Spike Glycoprotein, Coronavirus/metabolism