Assessing neurological symptoms present in long COVID patients

In a recent study published in Annals of Clinical and Translational Neurology, researchers assessed the symptoms of neurological post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (neuro-PASC) among patients with and without neurologic disorders.

Background

PASC or long-haul coronavirus disease (COVID) refers to the continuation/emergence of persistent COVID 2019 (COVID-19)-associated symptoms after the acute phase of infection. Studies have reported on acute and long-term neurological sequelae of COVID-19 including anxiety, fatigue, sleep disturbances, myalgia, and impaired memory in patients with severe or critical COVID-19. However, the neurological long-term PASC trajectory among patients with mild COVID-19 has not been extensively investigated.

About the study

In the present study, researchers explored the symptomatology of neuro-PASC among patients with and without neurologic disorders.

Individuals with neurological symptoms after the acute phase of COVID-19 were enrolled for the study between 9 October 2020 and 11 October 2021 from the outpatient neurology department and other departments of the University of California San Diego (UCSD) and self (outside UCSD) referrals. The individuals were categorized into two groups as follows: Group 1 comprised individuals without a history of neurological disorders before COVID-19 diagnosis and Group 2 comprised individuals with neurological disease history before being infected with SARS-CoV-2.

Data were obtained for demographics, prior COVID-19 history, neurological system review, neurological examination, Montreal cognitive assessment (MoCA), and symptom-based self-reported online surveys. The survey forms were filled out after the acute COVID-19 phase and at the six-month follow-up visit and all data were stored in the REDCap database.

The UCSD NeuCOVID assessment forms were filled out to obtain data on the patients’ SARS-CoV-2 infection test reports, COVID-19 symptoms, the status of vaccination, COVID-19 severity, hospital admissions, and recovery. Data on the method of SARS-CoV-2 detection such as via anterior nasal sample, nasopharyngeal swabs, antigen tests, or polymerase chain reaction (PCR) were also obtained.

The neurological symptom review comprised screening for symptoms such as fatigue, encephalopathy, headaches, insomnia, seizures, mood disorders, speech abnormalities, facial weakness, limb weakness, poor coordination of limbs, stiffness of muscles, numbness, and tingling. Other symptoms assessed included imbalance, falls, tremors, slow movements, difficulties in concentration, memory, hearing, vision, swallowing, chewing, walking, and the effect of the symptoms on patients’ quality of life. Severity scores were allotted for the symptoms on the numeric rating scale (NRS).

Neurological examination comprised assessment of cranial nerve function, reflexes, motor function, sensation, gait, and coordination at every visit. In the case of telemedicine consultations, facial sensations, extraocular movements, hearing, protrusion of the tongue, palate assessments, lateral movements of the head, and shrugging of shoulders were assessed for cranial nerve assessment.

Cognitive MoCA assessments were performed to evaluate the short-term memory, abstraction, executive functioning, orientation, visuospatial skills, and language. For telemedicine consultations, a MoCA copy for the examiner and a blank paper was used for the patient for assessing drawing and visual skills including trail-maker tasks, drawing cubes and clocks, and naming objects. Formal neuropsychologic evaluations were carried out for individuals with scores below 26.

Results

A total of 56 individuals were included in the analysis, of which the majority (69%) were women, the average age was 50 years and 29% had a history of neurological disorders like multiple sclerosis. Out of 56 patients enrolled, 27 completed the follow-up assessments. COVID-19 severity was mild and moderate in 39.3% and 42.9% of cases, respectively.

In the baseline evaluation (after the acute COVID-19 phase), the most frequent neurological symptoms reported were fatigue and headache in 89% and 80.4% of cases, respectively. Insomnia, memory impairments, and loss of concentration were reported in 66%, 64.3%, and 62.5% of the participants. The majority of the individuals (80%) reported that their PASC symptoms affected their quality of life.

At the follow-up visit (after six months of baseline), impaired memory and loss of concentration were the most persistent symptoms reported in 69% and 61.5% of cases, respectively, although lower severity scores were reported for all the symptoms. Quality of life continued to be reduced in comparison with that reported in the baseline evaluation for 16 (80%) individuals.  

Complete resolution of symptoms was noted for 33% of the study participants with an overall improvement in the mean MoCA scores. PASC-TAC (PASC-tremor, ataxia, and cognitive dysfunction) syndrome was detected in 7% of the participants.

Overall, the study findings showed that initial neuro-PASC phase, headaches, and fatigue were the most frequent symptoms. After six months, impaired memory and loss of concentration were the most prevalent symptoms. While neuro-PASC symptoms were completely resolved in six months among only 33% of the study participants, trends reflecting an improvement of persistent neurological symptoms were observed at the follow-up visit.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.