Neuropsychiatric issues have been frequently reported in coronavirus disease 2019 (COVID-19) long-haulers. A new study on the medRxiv* preprint server has found which neurological symptoms are likely to persist after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
The most commonly reported neurological complication was sleep disturbance. About 1 in 4 people experience sleep problems and fatigue. About 1 in 5 experience brain fog and anxiety, and another 15% of people reported post-traumatic stress disorder (PTSD).
The researchers suggest pinpointing the type of neurological symptoms being frequently exhibited could help tailor mental health service planning in the pandemic recovery phase. They write:
Our results imply that health services should plan for high rates of requirement for multidisciplinary services (including neurological, neuropsychiatric and psychological management) as populations recover from the COVID-19 pandemic.”
Looking back at past data
An international group of researchers performed a meta-analysis of 51 studies with 18,917 patients who exhibited at least one neurological complication 77 days after recovering from COVID-19.
Most of the 51 studies came from China, Italy, the United States, and the United Kingdom.
They identified the range of neuropsychiatric symptoms that were most common after COVID-19 — with little research suggesting the frequency of these symptoms are decreasing over time.
Initially, their meta-analysis excluded studies that did not have original reporting, were not peer-reviewed, only had preclinical data, or were non-English language. The quality of the studies was also taken into account. The team omitted studies where there was no positive test diagnosis for COVID-19, a small sample of fewer than 10 patients with COVID-19, no post-discharge patient data were available, or no neuropsychiatric symptoms were observed.
Trouble sleeping most reported neuropsychiatric long COVID-19 symptom
Of the 51 studies, the average age for a patient positive for COVID-19 was 50.9 years. About 33.2% of patients were male. While ethnicity was reported in only 12.6% of patients, 49.3% were White.
At 27.4%, problems sleeping was the most reported neuropsychiatric symptom amongst people with long COVID. This was followed by fatigue at 24.4%, cognitive impairments — known as brain fog — at 20.2%, anxiety at 19.1%, and post-traumatic stress at 15.7%.
Loss or altered sense of taste was the most common neurological symptom reported. This was followed by headache and then sensorimotor impairment. Dizziness or vertigo was also reported in less than 10% of patients.
There were only two studies where neuropsychiatric symptoms were found in control groups. However, the researchers note the number of symptoms was much greater in people who recovered from COVID-19 infection.
Hospitalization made no difference in developing neuropsychiatric symptoms
When looking at the prevalence of neuropsychiatric symptoms among hospitalized patients, the researchers found almost no difference with people who were not hospitalized. There was also almost no difference in developing neuropsychiatric symptoms among people who had a severe infection and were admitted into the intensive care unit (ICU). The only exception was for anxiety symptoms.
Across different time points, there was no difference in neuropsychiatric symptoms at different follow-up. “The prevalence of these symptoms appears to be relatively stable across different points in the first six months, between hospitalized and community samples, and among hospitalized patients regardless of COVID-19 severity,” concluded the research team.
Limitations and future research
Some research was self-reported, which could introduce subjective interpretations of neuropsychiatric symptoms. Future research would require controlled experiments where researchers would be able to differentiate neuropsychiatric symptoms specific to COVID-19 infection and symptoms from another viral illness.
There was very low ethnicity data in the meta-analysis, which could skew the actual number of neuropsychiatric symptoms associated with long COVID. Since the beginning of the pandemic, people of color have been disproportionally affected by COVID-19 and are more likely to experience severe infection and death than White people.
Classical epidemiological approaches may be required to generate representative community-based samples, and longer-term follow-up is required. Emerging prospective, longitudinal, and multicentre studies will probe the characteristics and aetiology of persistent neuropsychiatric symptoms in patients with COVID-19.”
It also remains unknown whether specific symptoms such as PTSD and anxiety could be treated using traditional psychological treatments for the condition. Since SARS-CoV-2 causes tissue and organ damage, research looking into multidisciplinary approaches may be necessary for proper rehabilitation.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.