Brain COVID: Common neuropsychological diagnosis within 6 months of infection

One-third of COVID-19 survivors received a neurological or psychiatric diagnosis within 6 months of being infected with SARS-CoV-2. An analysis of 236,000 electronic health records shows.

According to Paul Harrison and co-author of FRCPsych at Oxford University in the United Kingdom, the incidence of neuropathy or psychiatric disorders was 33.62% (95% CI 33.17% -34.07%).

Approximately 1 in 8 (12.84%, 95% CI 12.36% -13.33%) had never had a neuropsychiatric diagnosis prior to SARS-CoV-2 infection, the researchers reported. Lancet Psychiatry..

Anxiety (17%) and mood disorders (14%) were the most common. Neurological diagnoses such as stroke and dementia were rare and were more likely to occur in people with a serious illness with COVID-19: 7% of patients admitted to the intensive care room suffered from stroke , Nearly 2% were diagnosed with dementia.

“Many neurological diagnoses were more common after COVID-19 than after other infections or health events that occurred during the same period,” Harrison said. Today’s MedPage.. “This is the first time we have good data to show this...“”

“This was especially true for COVID patients who needed admission to the intensive care unit or who had encephalitis as part of their illness,” he added. Since COVID-19, psychiatric diagnoses such as anxiety and depression have been common, but “these were not strongly associated with the severity of the illness,” he said.

The findings suggest an increase in demand for neurology, psychiatry, and primary care services, he said.

The analysis was based on electronic health records of 236,379 COVID-19 patients aged 10 years and older on the TriNetX network. Mostly Americans who were infected after January 20, 2020 and survived December 13. The average age of the patients was 46 years and 56% were female. Almost one-third (30%) have hypertensive disease, 9% have ischemic heart disease, 18% have other forms of heart disease, 18% are overweight or obese, 16% have type 2 diabetes, and 10% have. Asthma, 7% had chronic kidney disease and 19% were neoplasms.

The matched controls included 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with respiratory tract infections (including influenza) during the same period. The researchers examined 14 results. Intracranial hemorrhage. Ischemic stroke; Parkinsonism; Gillan Valley syndrome; Nerve, nerve root, and neuropathy; neuromuscular junctions and muscle disorders; encephalitis; dementia; psychiatric, mood, and anxiety disorders (grouped and individualized); substance abuse ; And insomnia.

For outcomes that were chronic illnesses such as dementia and Parkinson’s disease, the research team excluded patients diagnosed prior to the index event. For outcomes that tend to recur (including ischemic stroke and psychiatric diagnosis), they were diagnosed at the incidence of the first diagnosis and the incidence of any diagnosis (ie, at some point prior to the index event). (Including patients) were estimated separately.

Most neuropathy or psychiatric disorders are more in COVID-19 patients than in influenza (HR 1.44, 95% CI 1.40-1.47 diagnosis; HR 1.78, 95% CI 1.68-1.89 first diagnosis) or airway patients It was common. Infectious diseases (HR 1.16, 95% CI 1.14-1.17 for all diagnoses, HR 1.32, 95% CI 1.27-1.36 for the first diagnosis). A sensitivity analysis comparing these results with the proportion of sequelae in influenza patients in 2019 and 2018 confirmed the findings.

The estimated incidence of the entire COVID-19 cohort was 0.56% for intracranial hemorrhage, 2.10% for ischemic stroke, 0.11% for Parkinson’s disease, 0.67% for dementia, 17.39% for anxiety disorders, and 1.40% for psychotic disorders. ..

For patients admitted to the intensive care unit, the estimated incidence of neurological or psychiatric diagnosis was 46.42%, with the initial diagnosis being 25.79%. The estimated incidence of ICU patients was 2.66% for intracranial hemorrhage, 6.92% for ischemic stroke, 0.26% for Parkinson’s disease, 1.74% for dementia, 19.15% for anxiety disorders, and 2.77% for psychotic disorders.

Compared to non-hospitalized patients, hospitalized COVID-19 patients generally have an HR of greater than 2 for neurological disorders such as stroke, Parkinsonism, Guillain-Barré syndrome, neuromuscular or muscular disease, encephalitis, and dementia. Was there. Psychiatric diagnoses, including accidental mood disorders (HR 1.53), anxiety disorders (HR 1.49), substance use disorders (HR 1.68), and insomnia (HR 1.49), showed a slightly smaller proportion.

“This is because almost all neurological and psychological outcomes were more frequent in patients with severe COVID-19 than in patients with mild illness, but these psychiatric disorders are a psychosocial aspect of infection. It suggests that it may be caused by common effects, including: Direct effects of COVID-19 on the brain, “said Jonathan Rogers (MRCPsych) and Anthony David (MD) of University College London, UK. ) Is Ancillary editorial..

The study “points us into the future, both in its way and in its meaning,” the editor added. “Researchers need to be able to use large-scale, international, real-world clinical data to observe and predict the neurological and psychological consequences of new health threats in the future. Sadly, this study Many of the disorders identified in are prone to chronic or recurrent, so it can be expected that the effects of COVID-19 may last for years. “

Harrison and co-authors said there were some limitations to the analysis. The integrity and accuracy of electronic health records was unknown. Many patients with COVID-19 have mild or no symptoms and do not seek treatment. This study may reflect people who are more seriously affected by the virus. The severity and course of neuropathy and psychiatric disorders were also unknown.