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In a recent study published in Research Square* preprint server, researchers assessed functional and microstructural brain abnormalities, fatigue, and cognitive impairment after mild coronavirus disease 2019 (COVID-19).
Studies have identified neurological symptoms of COVID-19, but little is known regarding the long-term neurological effects of severe acute respiratory syndrome (SARS-CoV-2) infection. While most people recover from respiratory symptoms, the prognosis for exhaustion and cognitive dysfunction after COVID-19 is questionable.
Although neuroinvasion following SARS-CoV-2 has been confirmed in some brain autopsies, the neural processes generating neuropsychiatric and neurological symptoms remain unknown.
About the research
In the current study, the researchers revealed functional connectivity abnormalities, clinical assessment, and neuropsychological assessments.
The team performed an analysis of cross-sectional data from an observational study aimed at investigating post-acute neurological signs and neuroimaging changes associated with COVID-19. used social media to publicize his online research. The first 87 participants who did not require hospitalization and had a confirmed diagnosis of COVID-19 had to visit the center and complete the four steps of the protocol: personal interview and neurological assessment, 3T magnetic resonance imaging (MRI) along with neuropsychological assessment. and taking a blood sample at the Hospital of the University of Campinas. COVID-19 is diagnosed by polymerase chain reaction (PCR) or checked immunoglobulin (Ig)-M or IgG antibodies. A total of 55 healthy volunteers did not exhibit symptoms of COVID-19 and had never tested SARS-CoV-2-positive.
The team conducted an exploratory neuropsychological assessment of recovered patients. Tests were chosen to examine individual cognitive domains, including language with the Phonemic Verbal Fluency Test and the Verbal Categorical Fluency Test, episodic memory with the Logical Memory subtest of the Wechsler Memory Scale Revised, and cognitive flexibility with the Trail Making Test.
The team determined z-scores corresponding to neuropsychological test scores using the Brazilian standard and scaled scores. An additional analysis with multiple linear regression residuals was also performed to adjust for the influence of age or education. For each test, function was classified as preserved, low average, below average, or very low. We measured symptoms of anxiety and depression using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II), respectively. The Chalder Fatigue Questionnaire (CFQ-11) and the Epworth Sleepiness Scale were also used to assess fatigue as well as excessive daytime sleepiness (ESS), respectively.
Results
The study results showed an average latency of 54 days between diagnosis and personal interview for the 87 patients we studied. Patients had an average of four symptoms during the acute phase, while they had an average of two symptoms in the post-acute phase. Fatigue, headache, memory problems, anosmia and drowsiness are the most common post-acute effects. In addition, 38 participants felt exhausted, often accompanied by other symptoms such as headache in 25 respondents, memory problems in 17 subjects and sleepiness in 14 subjects.
The team found abnormalities in 11 individuals based on a neurological examination and interview after COVID-19. Along with personal interviews, 65 respondents scored a median of 15 on the CFQ-11 and 9 on the ESS. In contrast to the number of symptoms noted at interview, symptoms indicated exhaustion in 44 of 65 individuals and excessive daytime sleepiness among 23 of 65 individuals.
Neuropsychological assessment was performed on a subset of 78 individuals. Almost 18% of people showed symptoms of depression, while 29% showed symptoms of anxiety. The team found a relationship between BDI-II and CFQ-11 scores. Regarding cognitive function, the team observed abnormal phonological fluency among 33% of patients, abnormal performance on the Trail Making Test (TMT)-A in 30% of patients, and abnormal performance on the TMT-B in 40% of patients. An association was also observed between higher fractional anisotropy (FA) values in patients and lower values of axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD).
Conclusion
The results of the study showed that SARS-CoV-2 affected the brains of patients who did not require hospitalization, with chronic fatigue, headache, memory impairment and sleepiness even two months after infection with SARS-CoV-2. The team identified these patients’ cognitive impairment, mild white matter and connectivity abnormalities. Brain changes and the severity of cognitive impairment warrant substantial longitudinal studies of persistent neuropsychiatric symptoms in patients reinfected with COVID-19, even in those with minimal acute symptoms. After the initial phase, specific symptomatic therapy and neurorehabilitation procedures may be required to improve cognitive function and quality of life in patients with permanent disabilities.
*Important message
Research Square publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guiding clinical practice/health-related behavior or treated as established information.
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