Leo Sher, M.D.

A research report, “Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study” has been published in the Lancet Psychiatry online ahead of print (1).

The aim of this study was to investigate complications of COVID-19 that affected the brain. British scientists developed an online network of rapid-response case report notification portals across the spectrum of major UK neuroscience organizations. Members of these professional organizations were emailed weekly to remind them of the surveillance programs. Clinical syndromes associated with the COVID-19 disease were classified as a cerebrovascular event (defined as an acute ischemic, hemorrhagic, or thrombotic vascular event involving 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 nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations).

Median patient age was 71 years (range 23–94). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischemic stroke, nine (12%) an intracerebral hemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

The authors noted that many patients with COVID-19 are managed in intensive care units with sedative and paralytic medications, which can both mask and contribute to iatrogenic neurological and neuropsychiatric complications. The authors also suggest that future studies on neurological and neuropsychiatric complications of COVID-19, particularly those assessing genetic and associated risk factors, would benefit from obtaining notification of all cases of COVID-19 admitted to every hospital as a denominator, or a cohort of COVID-19 patients without neurological or psychiatric complications as a control group. There was no funding source for this study.

Reference

1. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, Sultan M, Easton A, Breen G, Zandi M, Coles JP, Manji H, Al-Shahi Salman R, Menon DK, Nicholson TR, Benjamin LA, Carson A, Smith C, Turner MR, Solomon T, Kneen R, Pett SL, Galea I, Thomas RH, Michael BD; CoroNerve Study Group. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020 Jun 25:S2215-0366(20)30287-X. doi: 10.1016/S2215-0366(20)30287-X. Online ahead of print.