High Prevalence of Neurological Complaints One Year After COVID-19 Diagnosis

Highlights

Interest in the neurological complications of COVID-19 remains high and this prospective study evaluated the natural history of neurological manifestations over a 1-year period in 81 COVID-19 survivors.
More than half of the patients reported symptoms at one year, the most common being fatigue, concentration difficulties, forgetfulness, sleep disorders, myalgia, weakness in the extremities, headache, altered sensation, and hyposmia.
Cognitive impairment, objectively assessed using the MoCA, was prevalent and persistent in almost a fifth of patients, while almost a quarter of patients reported persistent forgetfulness and concentration difficulties 1 year after acute COVID-19. A high prevalence of neurological signs was found, almost up to two thirds of patients if objective hyposmia is included.
The authors report a significant prevalence of neurological complaints 1 year after COVID-19, with 12% having new-onset neurological disease within 12 months after COVID-19.

Background and objective

The neurological sequelae of coronavirus disease 2019 (COVID-19) may persist after recovery from an acute infection. Here, we aimed to describe the natural history of neurological manifestations more than 1 year after COVID-19.

Methods

A prospective, multicenter, longitudinal cohort study was conducted in COVID-19 survivors. At a 3-month and 1-year follow-up, patients were evaluated for neurological deficits using a neurological examination and a battery of standardized tests that included assessment of hyposmia (16-item Sniffin’ Sticks test), cognitive deficits (Cognitive Assessment of Montreal < 26) and mental health (Hospital Anxiety and Depression Scale and Post-Traumatic Stress Disorder Checklist 5).

Results

Eighty-one patients were evaluated 1 year after COVID-19, of whom 76 (94%) patients completed 3-month and 1-year follow-up.

The patients were 54 (47-64) years old and 59% were men. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year).

Symptoms at 1-year follow-up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disorders (22%), myalgia (17 %), weakness in the extremities (17%), headache (16%), altered sensation (16%) and hyposmia (15%).

Neurological examination revealed findings in 52/81 (64%) patients with no improvement over time (3 months, 61%, p = 0.230) including objective hyposmia (Sniffin’ Sticks test <13; 51%). Cognitive deficits were evident in 18%, while signs of depression, anxiety, and post-traumatic stress disorders were found in 6%, 29%, and 10%, respectively, one year after infection.

These mental and cognitive disorders had not improved after the 3-month follow-up (all p > 0.05).

High Prevalence of Neurological Complaints One Yea

Self-reported symptoms quantified by duration (any time, >4 weeks, >3 months, ≥1 year)

Conclusion

Our data indicate that a significant number of patients still suffer from neurological sequelae, including neuropsychiatric symptoms, 1 year after COVID-19, requiring interdisciplinary management of these patients.

Discussion

In this prospective longitudinal observational study, the natural history of neurological recovery from COVID-19 up to 1 year after diagnosis is described. The focus was on new and persistent neurological symptoms and diseases, as well as measures of fatigue/mental health in a mixed outpatient and inpatient population.

New-onset, mostly mild, neurological disease was found in 12% of the cohort within 12 months of COVID-19. The most common self-reported ongoing symptom was fatigue (38%), followed by concentration difficulties (25%), forgetfulness (25%), and sleep disturbances (22%).

Objective and relevant neurological signs are described in 64% of patients, with objective hyposmia (51%) being the most prevalent symptom. Impaired cognition (18%), signs of anxiety (29%), and depression (6%) were still present in a considerable number of patients.

It is now well accepted that COVID-19 can affect human health beyond acute infection.

In addition to pulmonary manifestations and other organ dysfunctions, neuropsychiatric symptoms and signs draw attention as long-term effects of COVID-19, with common representations being fatigue, headache, and attention disorders.

High Prevalence of Neurological Complaints One Year After COVID-19 Diagnosis

A high prevalence of neurological complaints persists one year after COVID-19 diagnosis, emphasizing the long-term impact of the disease on neurological function and the need for comprehensive post-acute care services for affected individuals.