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Frequency and Outcomes of Neurological Disorders Related to COVID-19
abstract
This abstract is available on the publisher's site.
Access this abstract nowDetermining the frequency and outcomes of neurological disorders associated with COVID-19 is imperative for understanding risks as well as recognition of emerging neurological disorders. We investigated the susceptibility and impact of SARS-CoV-2 infection among persons with premorbid neurological disorder rs, as well as the post-infection incidence of neurological sequelae in a case-control population-based cohort. Using health service data collected from March 1, 2020, to June 30, 2021, we constructed a cohort of SARS-CoV-2 RNA-positive (n=177,892) and -negative (n=177,800) adults who were age-, sex-, and comorbidity-matched and underwent RT- PCR testing at similar times. COVID-19 associated mortality rates were examined within the cohort. Neurological sequelae were analysed during the acute (less than three months) and the post-acute (three to nine months) phases post-infection. The risk of death was significantly greater in the SARS-CoV-2 RNA-positive (2,140 per 100,000 person years) compared to RNA-negative (922 per 100,000 person years) over a follow-up of 9 months, particularly amongst those with premorbid neurological disorders: adjusted odds ratios (aOR, 95% CI) in persons with a prior history of parkinsonism (1·65, 1·15-2·37), dementia (1·30, 1·11-1·52), seizures (1·91, 1·26-2·87), encephalopathy (1·82, 1·02-3·23), and stroke (1·74, 1·05-2·86). There was also a significantly increased risk for diagnosis of new neurological sequelae during the acute time phase after COVID-19 including encephalopathy (2·0, 1·10-3·64), dementia (1·36, 1·07-1·73), seizure (1·77, 1·22-2·56), and brain fog (1·96, 1·20-3·20). These risks persisted into the post-acute phase after COVID-19 during which inflammatory myopathy (2·57, 1·07-6·15) and coma (1·87, 1·22-2·87) also became significantly increased. Thus, persons with SARS-CoV-2 infection and premorbid neurological disorders are at greater risk of death while SARS-CoV-2 infection was complicated by increased risk of new onset neurological disorders in both the acute and post-acute phases of COVID-19.
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Increased frequency and mortality in persons with neurological disorders during COVID-19
Brain 2024 Apr 20;[EPub Ahead of Print], CM Marsters, JA Bakal, GY Lam, FA McAlister, C PowerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Since the landmark report1 from Wuhan, China, regarding the neurological manifestations of COVID-19, there has been considerable interest in both the short- and long-term neurological complications of COVID-19 and the outcomes of patients with pre-existing neurological diseases affected by COVID-19. Several large cohort studies have highlighted the association of encephalopathy (including long-term cognitive dysfunction, so-called "brain fog"), cerebrovascular disease, seizures, olfactory/gustatory dysfunction, headaches, and inflammatory disorders along the neurological axis with COVID-19 and increased risk of mortality in patients with neurological complications.2-6
In this study by Marsters et al, the authors utilized a population-based case–control cohort study in Alberta, Canada, to describe the frequency of neurological complications among patients with COVID-19 in the acute (7 days to 3 months) and post-acute (3 to 9 months) phases of care and examine the impact of neurological comorbidities on mortality. The cohort consisted of 177,892 patients who tested positive for SARS-CoV-2, among whom 4667 had a premorbid neurological disorder, and a control group of 177,800 patients matched for age, sex, and comorbidities. This is one of the largest case–control cohorts assembled to date, allowing the authors to perform nested case–control studies to address their study's aims.
During the acute phase of illness, greater odds of developing encephalopathy, dementia, seizure/epilepsy, and brain fog were observed; whereas, in the post-acute phase, greater odds of developing inflammatory myopathy, encephalopathy, dementia, seizure/epilepsy, brain fog, and coma were observed. Patients with COVID-19 exhibited higher odds of developing premorbid parkinsonism, inflammatory myopathy, encephalopathy, dementia, seizure/epilepsy, headache disorder, cerebrovascular diseases, and myelitis. Lastly, higher odds of mortality were observed for patients with COVID-19 if they had premorbid parkinsonism, encephalopathy, dementia, seizure/epilepsy, and hemorrhagic stroke.
Although individual case reviews for adjudicating neurological diagnoses would not have been practical given the size of the cohort, leading to the use of ICD-10-CA codes with a potential misclassification bias, this study suggests an association of specific neurological disorders (either as premorbid conditions or new-onset complications) with COVID-19 and increased mortality risk. The absence of an association with stroke in the acute phase is notable given the volume of the literature on cerebrovascular and thrombotic diseases in the first COVID-19 wave, which, as the authors commented, may be accounted for by differences in the population and variable definitions of acuity. The implications of these findings at a population health level could be considerable, taking into account the long-term impacts of cognitive dysfunction, muscle weakness, and epilepsy both in terms of patient experience and healthcare expenditure and the potential to maximize preventive health efforts by including those with neurological disorders in the category of a higher risk of death and disability from COVID-19.
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