Neurologic Aspects of Coronavirus Disease of 2019 Infection

Catherine E. Hassett; Jennifer A. Frontera

Disclosures

Curr Opin Infect Dis. 2021;34(3):217-227. 

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Long-term Neurocognitive Impairment

Neurocognitive impairment has been well documented across both acute and chronic pulmonary illnesses.[75] Nearly 100% of non-COVID ARDS survivors exhibit impaired cognitive performance at discharge with a range of 46–78% continuing to demonstrate cognitive deficits 1-year postdischarge.[77] While all domains of cognition can be impacted, chronic memory impairment has been most commonly reported following non-COVID ARDS. While the long-term cognitive impact remains to be seen in COVID-19 patients, current reports of post-COVID syndrome have included symptoms such as mental fatigue, memory impairment, and dysexecutive syndrome.[78] A small retrospective study found risk factors for neurocognitive impairment in hospitalized COVID-19 survivors included severe infection, hypoxemia requiring mechanical ventilation, and increased inflammatory markers.[79] Other studies suggest that prominent cognitive effects can occur after mild COVID-19 infections.[80] Neurorehabilitation programs for COVID-19 patients have anecdotally reported improvement in COVID-related neurocognitive symptoms by targeting alertness, circadian rhythm disorders, and behavioral disturbances.

An observational prospective study evaluating long-term cardiovascular consequences after COVID-19 infection reported prolonged vessel inflammation on cardiac MRI independent of preexisting conditions, severity and overall course of acute illness.[81] There are unknown long-term systemic consequences from COVID-19 infection, but it is plausible that prolonged systemic inflammation may contribute to CNS-related symptoms. Further investigations are needed to understand the long-term prognosis and neuropsychological impact of COVID-19.

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