Neurologic Manifestations of Long COVID Disproportionately Affect Young and Middle-Age Adults

• Published in: Annals of neurology 2024-11
• Main Authors: Choudhury, Natasha A, Mukherjee, Shreya, Singer, Tracey, Venkatesh, Aditi, Perez Giraldo, Gina S, Jimenez, Millenia, Miller, Janet, Lopez, Melissa, Hanson, Barbara A, Bawa, Aasheeta P, Batra, Ayush, Liotta, Eric M, Koralnik, Igor J
• Format: Article
• Language: English
• ISSN: 0364-5134; 1531-8249; 1531-8249
• DOI: 10.1002/ana.27128

To investigate neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients across the adult lifespan. Cross-sectional study of the first consecutive 200 PNP and 1,100 NNP patients evaluated at a Neuro-coronavirus disease 2019 (COVID-19) clinic between May 2020 and March 2023. Patients were divided into younger (18-44 years), middle-age (45-64 years), and older (65+ years) age groups. Younger and middle-age individuals accounted for 142 of 200 (71%) of PNP and 995 of 1100 (90.5%) of NNP patients. Significant age-related differences in the frequencies of comorbidities and abnormal neurologic findings demonstrated higher prevalence in older patients. Conversely, 10 months from COVID-19 onset, we found significant age-related differences in Neuro-PASC symptoms indicating lower prevalence, and therefore, symptom burden, in older individuals. Moreover, there were significant age-related differences in subjective impression of fatigue (median [interquartile range (IQR)] patient-reported outcomes measurement information system [PROMIS] score: younger 64 [57-69], middle-age 63 [57-68], older 60.5 [50.8-68.3]; p = 0.04) and sleep disturbance (median [IQR] PROMIS score: younger 57 [51-63], middle-age 56 [53-63], older 54 [46.8-58]; p = 0.002) in the NNP group, commensurate with higher impairment in quality of life (QoL) among younger patients. Finally, there were significant age-related differences in objective executive function (median [IQR] National Institutes of Health [NIH] toolbox score: younger 48 [35-63], middle-age 49 [38-63], older 54.5 [45-66.3]; p = 0.01), and working memory (median [IQR] NIH toolbox score: younger 47 [40-53], middle-age 50 [44-57], older 48 [43-58]; p = 0.0002) in NNP patients, with the worst performance coming from the younger group. Younger and middle-age individuals are disproportionally affected by Neuro-PASC regardless of acute COVID-19 severity. Although older people more frequently have abnormal neurologic findings and comorbidities, younger and middle-age patients suffer from a higher burden of Neuro-PASC symptoms and cognitive dysfunction contributing to decreased QoL. Neuro-PASC principally affects adults in their prime, contributing to profound public health and socioeconomic impacts warranting dedicated resources for prevention, diagnosis and interventions. ANN NEUROL 2024.