Neurologic symptoms of long COVID more common in younger adults

Key takeaways:

• Adults aged 18 to 64 years had a greater neurological burden of long COVID than those aged 65 years and older.
• Symptoms often included fatigue, sleep issues and memory executive function.

Younger and middle-aged adults were more often affected by neurologic symptoms of long COVID than their older counterparts, regardless of how severe their initial infection was, data in Annals of Neurology show.

“This is the first study to characterize the neurologic manifestations of long COVID across the adult lifespan, comparing young, middle-aged and older individuals,” Igor J. Koralnik, MD, chief of neuroinfectious diseases and global neurology at Northwestern Medicine and co-director of the Northwestern Medicine Comprehensive COVID-19 Center, told Healio in an email.

Koralnik and colleagues conducted a cross-sectional study to examine the neurologic implications of post-acute COVID-19 sequelae (neuro-PASC) in participants who were previously hospitalized for severe COVID-19-related pneumonia (n = 200) vs. those who had milder COVID-19 and did not require hospitalization (n = 1,100). All participants had persistent neurologic symptoms lasting at least 6 weeks from viral onset.

The participants were evaluated during 1-hour sessions conducted either in person or via telehealth between May 2020 and March 2023. Prior to their evaluations, the participants completed questionnaires from the patient-reported outcomes measurement information system (PROMIS), which provided quality of life data on cognition, sleep issues, anxiety and depression.

A comprehensive neurologic exam was conducted during in-person evaluations. Certain parts of the exam, including full cranial nerve assessments, muscle strength, reflexes and sensation, were limited for those who were only seen via telehealth.

Additionally, all willing participants able to be seen in the clinic were given the NIH Toolbox version 2.1 assessment for cognitive function, which measured processing speed, attention span, executive function and working memory.

The participants were divided into age groups. Overall, there were:

40 younger adults aged 18 to 44 years who were hospitalized and 542 who were not hospitalized;

102 middle-aged adults aged 45 to 64 years who were hospitalized and 453 who were not; and

58 older adults aged 65 years and older who were hospitalized and 105 who were not.

Overall, older adults more often had abnormal neurologic findings, “likely corresponding with a higher burden of pre-existing comorbidities,” the researchers wrote.

However, Koralnik and colleagues noted significant age-related differences in neuro-PASC symptoms, with a lower prevalence and symptom burden in older individuals compared with their younger counterparts 10 months after COVID-19 onset, “regardless of the severity of their acute COVID-19 and hospitalization status.”

Specifically, the data revealed greater PROMIS scores in younger and middle-aged adults vs. older adults for fatigue (younger, 64; middle aged, 63; older, 60.5) and sleep disturbance (younger, 57; middle aged, 56; older, 54) in the non-hospitalized group.

The researchers also found significant age-related differences in objective executive function (median NIH toolbox scores: younger, 48; middle aged, 49; older, 54.5), and working memory (younger, 47; middle aged, 50; older, 48) in the non-hospitalized group, with younger patients recording the worst performances.

“Neurologic manifestations of long COVID principally affect young and middle-aged adults in their prime, which contributing to profound public health and socioeconomic impacts warranting dedicated resources for prevention, diagnosis and interventions,” Koralnik said.

Reference:

• New research shows younger and middle-aged adults have worse long COVID symptoms than older adults. https://news.nm.org/new-research-shows-younger-and-middle-aged-adults-have-worse-long-covid-symptoms-than-older-adults/. Published Nov. 22, 2024. Accessed Nov. 22, 2024.