Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study

Verena Rass; Ronny Beer; Alois Josef Schiefecker; Mario Kofler; Anna Lindner; Philipp Mahlknecht; Beatrice Heim; Victoria Limmert; Sabina Sahanic; Alex Pizzini; Thomas Sonnweber; Ivan Tancevski; Christoph Scherfler; Laura Zamarian; Rosa Bellmann-Weiler; Günter Weiss; Atbin Djamshidian; Stefan Kiechl; Klaus Seppi; Judith Loeffler-Ragg; Bettina Pfausler; Raimund Helbok

doi:10.1111/ene.14803

Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study

Eur J Neurol. 2021 Oct;28(10):3348-3359. doi: 10.1111/ene.14803. Epub 2021 May 3.

Authors

Verena Rass¹, Ronny Beer¹, Alois Josef Schiefecker¹, Mario Kofler¹, Anna Lindner¹, Philipp Mahlknecht¹, Beatrice Heim¹, Victoria Limmert¹, Sabina Sahanic², Alex Pizzini², Thomas Sonnweber², Ivan Tancevski², Christoph Scherfler¹, Laura Zamarian¹, Rosa Bellmann-Weiler², Günter Weiss², Atbin Djamshidian¹, Stefan Kiechl¹, Klaus Seppi¹, Judith Loeffler-Ragg², Bettina Pfausler¹, Raimund Helbok¹

Affiliations

¹ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
² Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.

Abstract

Background and purpose: To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.

Methods: In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist-5) 3 months after disease onset.

Results: Of 135 consecutive COVID-19 patients, 31 (23%) required intensive care unit (ICU) care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient care (mild) during acute disease. At the 3-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included polyneuro/myopathy (n = 17, 13%) with one patient presenting with Guillain-Barré syndrome, mild encephalopathy (n = 2, 2%), parkinsonism (n = 1, 1%), orthostatic hypotension (n = 1, 1%), and ischemic stroke (n = 1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at the 3-month follow-up. Self-reported hyposmia/anosmia was lower (17%) at 3 months, however, improved when compared to the acute disease phase (44%; p < 0.001). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety, and posttraumatic stress disorders in 11%, 25%, and 11%, respectively.

Conclusions: Despite recovery from the acute infection, neurological symptoms were prevalent at the 3-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.

Keywords: COVID-19; SARS-CoV-2; neuro-COVID; neurologic manifestations; quality of life.

Publication types

Multicenter Study
Observational Study

MeSH terms

COVID-19*
Cohort Studies
Humans
Prospective Studies
Quality of Life
SARS-CoV-2
Stroke*