Post-acute neurological sequalae of SARS-COV-2 infection

ABSTRACT

Objective: To investigate associations of COVID-19 illness severity in individuals who have developed objective or subjective neurologic findings after infection. Background: Following recovery from acute COVID-19 illness many patients report onset of new cognitive and neurological symptoms which can be disabling. Design/Methods: Early in the pandemic, in response to clinical experience and emerging research on post-acute neurological sequelae (PANS) of COVID-19, we created an IRB-approved patient registry in the Department of Neurology. Participants included are both retrospectively identified patients located through a search of all existing patients from Neurology outpatient practices at Columbia University Irving Medical Center with any COVID-19 related diagnosis, plus newly referred patients with PANS. Those included met CDC criteria of either suspected, probable, or confirmed COVID-19 (N=121). Information was obtained retrospectively through chart review and prospectively through symptom questionnaire and mini-MoCA. Analysis was performed with Chi-squared test and Pearson's correlation. Results: Our cohort was 72.7% women, mean age 47.9, 54.2% white, 16.7% Hispanic/Latino, 6.7% Black/African American, and 5% Asian. 55.45% had a prior neurological diagnosis, most commonly headache (23.1%). 68.8% had both clinical and lab definite COVID-19 infection, 23.1% required hospitalization, and 9.1% ICU care. 72.2% reported no worsening of prior neurological symptoms but 81.8% developed new neurological symptoms including general cognitive complaints (47.9%), attention difficulty (42.1%), word finding difficulty (36.4%), vestibular complaints (23.1%), and fatigue (19.8%). Mini-MoCAs were administered to 37 subjects (median score 12/15). Hospitalization for COVID-19 correlated with subjective “brain fog” (p= .009) and attention difficulty (p= .011). ICU requirement correlated with subjective word finding difficulty (p= .049), “brain fog” (p= .034), and attention difficulty (p= .020). There was a relationship between length of hospitalization and mini MoCA score (p= .006). Conclusions: In this patient sample, severity of infection assessed through surrogate measures of hospitalization and ICU requirement are associated with subjective and objective post COVID19 neurological dysfunction.