Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”

• Published in: Annals of Clinical and Translational Neurology 2021-05, Vol.8 (5), p.1073-1085
• Main Authors: Graham, Edith L., Clark, Jeffrey R., Orban, Zachary S., Lim, Patrick H., Szymanski, April L., Taylor, Carolyn, DiBiase, Rebecca M., Jia, Dan Tong, Balabanov, Roumen, Ho, Sam U., Batra, Ayush, Liotta, Eric M., Koralnik, Igor J.
• Format: Article
• Language: English
• Subjects: Adult; Anxiety; Cognition & reasoning; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - etiology; COVID-19 - psychology; Demographics; Disease; Ethnicity; Fatigue; Fatigue - diagnosis; Fatigue - etiology; Fatigue - psychology; Female; Headache - diagnosis; Headache - etiology; Headache - psychology; Hispanic Americans; Hospitalization; Humans; Hypoxemia; Insomnia; Laboratories; Male; Memory; Middle Aged; Nervous System Diseases - diagnosis; Nervous System Diseases - etiology; Nervous System Diseases - psychology; Olfaction disorders; Pandemics; Patients; Pneumonia; Post-Acute COVID-19 Syndrome; Prospective Studies; Quality of life; Serology; Standard deviation; Taste disorders; Telemedicine - methods; Telemedicine - trends
• ISSN: 2328-9503; 2328-9503
• DOI: 10.1002/acn3.51350

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 (SARS‐CoV‐2+) and 50 laboratory‐negative (SARS‐CoV‐2‐) 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%), and 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