Most patients with COVID-19-linked disorders of consciousness recover

Patients with COVID-19-associated disorders of consciousness who survived the infection were highly likely to regain consciousness, according to results of a prospective, multimodal study.

“Impaired consciousness was observed in 1[% to] 20% of patients with COVID-19, mostly in patients with severe infection and comorbidities,” David Fischer, MD, of the department of neurology at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote in Neurology. “It soon became evident that these disorders of consciousness in severe COVID-19 (COVID-DoC) may be prolonged, carrying an unclear prognosis for neurologic recovery. This uncertainty has had profound implications.”

Researchers aimed to outline the natural history of COVID-DoC and examine its link to the brain connectivity profile. At a single institution, they screened consecutive patients with COVID-19 and enrolled 12 critically ill adult patients (median age, 63.5 years) with a DoC that was not explained by sedation or structural brain injury and who were intended to receive a brain MRI. They conducted resting state functional MRI and diffusion MRI for assessment of these patients’ functional and structural connectivity and compared their outcomes with those of healthy controls and patients with DoC following severe traumatic brain injury. At hospital discharge, 3 months after discharge and 6 months after discharge, they examined the recovery of consciousness and functional outcomes. They also examined whether an association existed between clinical variables and recovery from COVID-DoC.

Aside from one patient who died shortly after enrollment, the remaining patients recovered consciousness between 0 and 25 days after cessation of continuous IV sedation, with a median of 7 days. All patients who survived remained dependent at discharge; however, aside from two patients with severe polyneuropathy, all went home with normal cognition and minimal disability, with a median Glasgow Outcome Scale Extended (GOSE) score of 3 and a median Disability Rating Scale (DRS) score of 7 at 3 months, as well as median GOSE score of 4 and median DRS score of 3 at 6 months. A total of 10 patients with COVID-DoC received advanced neuroimaging, which revealed diminished functional and structural brain connectivity among those with COVID-DoC vs. health controls, as well as comparable structural connectivity among patients with COVID-DoC and those with severe TBI.

“Though rates of disability are high immediately following hospital discharge, such disability is mostly due to the sequelae of prolonged medical illness, and patients frequently improve substantially in the ensuing months,” Fischer and colleagues wrote. “Moreover, COVID-DoC appears to be associated with loss of functional and structural brain connectivity, findings common to other DoCs caused by brain injury. While future research is necessary to further characterize COVID-DoC, these findings help inform the prognosis and pathophysiology of COVID-DoC, a condition fraught with uncertainty.”