COVID-19 infection linked to acute neurological, psychiatric complications

COVID-19 infection appeared associated with several acute neurological and psychiatric complications, according to results of a surveillance study conducted in the U.K. and published in The Lancet Psychiatry.

“Most published reports on the neurological complications of COVID-19 are limited to individual cases or small case series,” Aravinthan Varatharaj, MRCP, of the University of Southampton Faculty of Medicine, and colleagues wrote. “A few studies showed the benefits of identifying patients with neurological complications across centers. However, these studies have largely been limited to two or three hospitals and are restricted by both geography and specialty, therefore not assessing the neurological and neuropsychiatric complications of COVID-19 across the clinical spectrum of neurology, stroke or acute medicine, psychiatry and intensive care.”

In the current study, the investigators sought to provide an integrated and comprehensive epidemiological characterization of COVID-19’s effects on the brain. They developed an online network of rapid-response case report notification portals across the spectrum of major neuroscience bodies in the U.K. during the pandemic’s exponential phase. To represent the fields of neurology, stroke, psychiatry and intensive care, the researchers included in the network the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP) and the Royal College of Psychiatrists (RCPsych).

They classified broad clinical syndromes linked to COVID-19 as the following:

• Cerebrovascular event, defined as an acute ischaemic, haemorrhagic or thrombotic vascular event that involved the brain parenchyma or subarachnoid space;

• altered mental status, defined as an acute alteration in personality, behavior, cognition or consciousness;

• peripheral neurology, defined as involving muscle, neuromuscular junction, peripheral nerves or nerve roots; or

• other, which included free text boxes for those who did not meet these syndromic presentations.

Varatharaj and colleagues encouraged physicians to prospectively report cases, and they allowed recent cases to receive retrospective notification when assigned a confirmed admission date or initial clinical assessment, which allowed for identification of cases that occurred before the availability of notification portals. The researchers compared collected data with the demographic, temporal and geographical presentation of overall cases of COVID-19 according to reporting by public health bodies of the U.K. government.

Data of 153 unique cases that met the clinical case definition by U.K. clinicians revealed a median patient age of 71 years. A total of 125 (82%) had complete clinical datasets available. Results showed 62% of patients presented with a cerebrovascular event, of whom 74% had an ischaemic stroke, 12% an intracerebral haemorrhage and 1% central nervous system vasculitis. Further, altered mental status occurred among 31% of patients, of whom 23% had unspecified encephalopathy and 18% encephalitis. The rest (59%) with altered mental status met the clinical case definition for psychiatric diagnoses according to the notifying psychiatrist or neuropsychiatrist, and 92% of these were new diagnoses.

Results also showed 43% of patients with neuropsychiatric disorders had new-onset psychosis, 26% had a neurocognitive/dementia-like syndrome and 17% had an affective disorder. Nearly half (49%) of patients with altered mental status were younger than 60 years and 51% were older than 60 years. Further, 18% of patients with cerebrovascular events were younger than 60 years vs. 82% of patients older than 60 years.

“Our nationwide, clinician-reported cohort approach provides valuable and timely information that is urgently needed by clinicians, researchers and funders to inform the immediate next steps in COVID-19 neuroscience-related research and health policy planning,” the researchers wrote. “These national data begin to characterize the spectrum of neurological and neuropsychiatric complications that need to be addressed. This multidisciplinary, coordinated approach should be emulated in detailed national mechanistic studies of COVID-19 and the brain to distinguish the role of the virus and the host inflammatory response vs. the broader socioeconomic effects of the pandemic.”