In the continuing evolution of the coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), more information is emerging regarding how the virus affects the human body.
Studies have shown that COVID-19 is not exclusively a respiratory disorder, but may also affect the cardiovascular, digestive, and nervous systems.
In a new study, published in the journal JAMA Network, University of Pittsburgh researchers for the Global Consortium Study of Neurologic Dysfunction in COVID-19 found that neurological manifestations were prevalent among patients hospitalized with COVID-19. The patients were also at a higher risk of in-hospital mortality.
The team revealed that 82 percent of the COVID-19 hospitalized patients developed neurologic complications and were six times more likely to die. While most of the conditions were mild to moderate, about half of the patients experienced altered brain function or structure, while approximately one in five patients was in a coma.
COVID-19 and neurological manifestations
As the pandemic continues, more and more reports of concomitant neurological manifestations of COVID-19 have emerged, including headache, anosmia or the loss of smell, ageusia or the loss of taste, and myalgia or muscle pain. Additionally, neurological disorders including encephalopathy, coma, and strokes were reported.
Since there is limited information regarding the extent of neurological symptoms and manifestations among COVID-19 patients, the current study was designed to analyze the incidence of COVID-19 neurological manifestations among global cohorts of hospitalized patients and identify possible risk factors associated with the onset of these manifestations.
The study population was derived from two large consortia. The first one is the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID), a large multicenter cohort study set up to establish the incidence, severity, and clinical outcomes of neurological manifestations among COVID-19 patients. Next, the team also derived study participants from the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY), a prospective registry created to assess the incidence of COVID-19 neurological manifestations and their outcomes six and 12 months.
Overall, the study included 3,744 hospitalized adult COVID-19 patients at 28 centers in 13 countries between March and October 2020.
The study results showed that across all cohorts, headache was the most common self-reported symptom, experienced by 38 percent of all COVID-19 cohort, 35 percent in the COVID-19 neurological cohort, and 27 percent in the ENERGY cohort, resulting in an average of 37 percent.
The other symptoms that followed included anosmia and ageusia, and syncope.
Among all the syndromes noted, acute encephalopathy was the most common neurological syndrome in all groups, with 50 percent of patients reporting it in the COVID-19 cohort, 53 percent in the COVID-19 neurological cohort, and 24 percent in the ENERGY cohort.
The incidence of acute encephalopathy increased with age, from 33 percent in younger than 40 patients to 74 percent in those who are older than 80.
Coma and stroke followed, with 17 percent and 3 percent of patients experiencing these, respectively. The least common neurological syndromes were meningitis and encephalitis.
The researchers emphasized that acute encephalopathy is the most common neurological complication among COVID-19 patients. Often, these patients manifest an altered sensory state, impaired consciousness, and they do not feel like themselves. These patients may also become confused, agitated, and delirious.
Further, the team explained that some people are at a higher risk of developing neurological symptoms and syndromes. Those who are at high risk include people with a preexisting neurological condition, such as Alzheimer’s disease, dementia, and brain, spinal cord, or nerve impairments.
“This multicenter cohort study found that neurological manifestations in COVID-19 were highly prevalent and associated with premature mortality,” the team explained.
“Using a global network with standardized protocols and common data elements is critical to facilitate further studies to understand COVID-19 neurological manifestations, including disease progression, associations with long-term outcomes, pathobiological mechanisms, and societal impact,” they concluded.