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

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 p...

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Published in:	European journal of neurology Vol. 28; no. 10; pp. 3348 - 3359
Main Authors:	Rass, Verena, Beer, Ronny, Schiefecker, Alois Josef, Kofler, Mario, Lindner, Anna, Mahlknecht, Philipp, Heim, Beatrice, Limmert, Victoria, Sahanic, Sabina, Pizzini, Alex, Sonnweber, Thomas, Tancevski, Ivan, Scherfler, Christoph, Zamarian, Laura, Bellmann‐Weiler, Rosa, Weiss, Günter, Djamshidian, Atbin, Kiechl, Stefan, Seppi, Klaus, Loeffler‐Ragg, Judith, Pfausler, Bettina, Helbok, Raimund
Format:	Journal Article
Language:	English
Published:	England John Wiley & Sons, Inc 01.10.2021 John Wiley and Sons Inc
Subjects:	Anosmia Anxiety Basal ganglia Central nervous system diseases Cognitive ability Cohort analysis COVID-19 Disease Disorders Encephalopathy Hypotension Infectious Diseases Ischemia Mental depression Mental health Movement disorders Myopathy neurologic manifestations neuro‐COVID Observational studies Olfaction disorders Original Patients Post traumatic stress disorder Quality of life SARS‐CoV‐2 Signs and symptoms Viral diseases COVID-19 SARS-CoV-2 neurologic manifestations quality of life neuro-COVID
ISSN:	1351-5101, 1468-1331, 1468-1331
Online Access:	Get full text
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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. Three months after COVID‐19, 20/135 patients (15%) presented with one or more neurological syndromes that were not evident before disease onset. Objective testing revealed hyposmia/anosmia in 45% of patients at the 3‐month follow‐up in comparison to 17% who reported hyposmia/anosmia. Cognitive deficits were apparent in 23%, quality of life was impaired in 31%, depression was found in 11%, anxiety in 25% and posttraumatic stress disorders in 11%.
AbstractList	Three months after COVID‐19, 20/135 patients (15%) presented with one or more neurological syndromes that were not evident before disease onset. Objective testing revealed hyposmia/anosmia in 45% of patients at the 3‐month follow‐up in comparison to 17% who reported hyposmia/anosmia. Cognitive deficits were apparent in 23%, quality of life was impaired in 31%, depression was found in 11%, anxiety in 25% and posttraumatic stress disorders in 11%. To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.BACKGROUND AND PURPOSETo assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.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.METHODSIn 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.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.RESULTSOf 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.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.CONCLUSIONSDespite 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. To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19. 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. 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. 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. 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. Three months after COVID‐19, 20/135 patients (15%) presented with one or more neurological syndromes that were not evident before disease onset. Objective testing revealed hyposmia/anosmia in 45% of patients at the 3‐month follow‐up in comparison to 17% who reported hyposmia/anosmia. Cognitive deficits were apparent in 23%, quality of life was impaired in 31%, depression was found in 11%, anxiety in 25% and posttraumatic stress disorders in 11%. Background and purposeTo assess neurological manifestations and health‐related quality of life (QoL) 3 months after COVID‐19.MethodsIn 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.ResultsOf 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.ConclusionsDespite 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.
Author	Mahlknecht, Philipp Kiechl, Stefan Loeffler‐Ragg, Judith Bellmann‐Weiler, Rosa Beer, Ronny Schiefecker, Alois Josef Sahanic, Sabina Zamarian, Laura Weiss, Günter Tancevski, Ivan Lindner, Anna Limmert, Victoria Djamshidian, Atbin Rass, Verena Seppi, Klaus Pfausler, Bettina Helbok, Raimund Heim, Beatrice Pizzini, Alex Sonnweber, Thomas Kofler, Mario Scherfler, Christoph
AuthorAffiliation	1 Department of Neurology Medical University of Innsbruck Innsbruck Austria 2 Department of Internal Medicine II Medical University of Innsbruck Innsbruck Austria
AuthorAffiliation_xml	– name: 1 Department of Neurology Medical University of Innsbruck Innsbruck Austria – name: 2 Department of Internal Medicine II Medical University of Innsbruck Innsbruck Austria
Author_xml	– sequence: 1 givenname: Verena orcidid: 0000-0002-4241-5891 surname: Rass fullname: Rass, Verena organization: Medical University of Innsbruck – sequence: 2 givenname: Ronny orcidid: 0000-0002-4341-6845 surname: Beer fullname: Beer, Ronny organization: Medical University of Innsbruck – sequence: 3 givenname: Alois Josef surname: Schiefecker fullname: Schiefecker, Alois Josef organization: Medical University of Innsbruck – sequence: 4 givenname: Mario orcidid: 0000-0002-3800-8417 surname: Kofler fullname: Kofler, Mario organization: Medical University of Innsbruck – sequence: 5 givenname: Anna orcidid: 0000-0003-0622-8033 surname: Lindner fullname: Lindner, Anna organization: Medical University of Innsbruck – sequence: 6 givenname: Philipp orcidid: 0000-0003-0671-0516 surname: Mahlknecht fullname: Mahlknecht, Philipp organization: Medical University of Innsbruck – sequence: 7 givenname: Beatrice surname: Heim fullname: Heim, Beatrice organization: Medical University of Innsbruck – sequence: 8 givenname: Victoria surname: Limmert fullname: Limmert, Victoria organization: Medical University of Innsbruck – sequence: 9 givenname: Sabina orcidid: 0000-0002-0583-9310 surname: Sahanic fullname: Sahanic, Sabina organization: Medical University of Innsbruck – sequence: 10 givenname: Alex surname: Pizzini fullname: Pizzini, Alex organization: Medical University of Innsbruck – sequence: 11 givenname: Thomas orcidid: 0000-0002-5080-386X surname: Sonnweber fullname: Sonnweber, Thomas organization: Medical University of Innsbruck – sequence: 12 givenname: Ivan orcidid: 0000-0001-5116-8960 surname: Tancevski fullname: Tancevski, Ivan organization: Medical University of Innsbruck – sequence: 13 givenname: Christoph orcidid: 0000-0002-4885-5265 surname: Scherfler fullname: Scherfler, Christoph organization: Medical University of Innsbruck – sequence: 14 givenname: Laura orcidid: 0000-0002-1640-4179 surname: Zamarian fullname: Zamarian, Laura organization: Medical University of Innsbruck – sequence: 15 givenname: Rosa orcidid: 0000-0002-5584-111X surname: Bellmann‐Weiler fullname: Bellmann‐Weiler, Rosa organization: Medical University of Innsbruck – sequence: 16 givenname: Günter orcidid: 0000-0003-0709-2158 surname: Weiss fullname: Weiss, Günter organization: Medical University of Innsbruck – sequence: 17 givenname: Atbin orcidid: 0000-0001-7174-6000 surname: Djamshidian fullname: Djamshidian, Atbin organization: Medical University of Innsbruck – sequence: 18 givenname: Stefan orcidid: 0000-0002-9836-2514 surname: Kiechl fullname: Kiechl, Stefan organization: Medical University of Innsbruck – sequence: 19 givenname: Klaus orcidid: 0000-0001-6503-1455 surname: Seppi fullname: Seppi, Klaus organization: Medical University of Innsbruck – sequence: 20 givenname: Judith orcidid: 0000-0003-0873-7501 surname: Loeffler‐Ragg fullname: Loeffler‐Ragg, Judith organization: Medical University of Innsbruck – sequence: 21 givenname: Bettina surname: Pfausler fullname: Pfausler, Bettina organization: Medical University of Innsbruck – sequence: 22 givenname: Raimund orcidid: 0000-0001-5682-0145 surname: Helbok fullname: Helbok, Raimund email: raimund.helbok@tirol-kliniken.at, raimund.helbok@i-med.ac.at organization: Medical University of Innsbruck
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/33682276$$D View this record in MEDLINE/PubMed
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Snippet	Background and purpose To assess neurological manifestations and health‐related quality of life (QoL) 3 months after COVID‐19. Methods In this prospective,... To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19. In this prospective, multicenter, observational cohort... Background and purposeTo assess neurological manifestations and health‐related quality of life (QoL) 3 months after COVID‐19.MethodsIn this prospective,... To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.BACKGROUND AND PURPOSETo assess neurological... Three months after COVID‐19, 20/135 patients (15%) presented with one or more neurological syndromes that were not evident before disease onset. Objective...
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SubjectTerms	Anosmia Anxiety Basal ganglia Central nervous system diseases Cognitive ability Cohort analysis COVID-19 Disease Disorders Encephalopathy Hypotension Infectious Diseases Ischemia Mental depression Mental health Movement disorders Myopathy neurologic manifestations neuro‐COVID Observational studies Olfaction disorders Original Patients Post traumatic stress disorder Quality of life SARS‐CoV‐2 Signs and symptoms Viral diseases
Title	Neurological outcome and quality of life 3 months after COVID‐19: A prospective observational cohort study
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