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26-07-2023 | COVID-19 | Original Communication

Longitudinal analysis and treatment of neuropsychiatric symptoms in post-acute sequelae of COVID-19

Authors: Emilie N. Liu, Jennifer H. Yang, Lucas Patel, Jasmine Arora, Amanda Gooding, Ronald Ellis, Jennifer S. Graves

Published in: Journal of Neurology | Issue 10/2023

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Abstract

Background

Persistent neuropsychiatric symptoms following acute COVID-19 infection are frequently reported. These include anxiety, depression, difficulty concentrating, fatigue, and insomnia. The longitudinal evolution of this neuropsychiatric burden is poorly understood and clinical guidelines concerning treatment are lacking.

Objective

We sought to describe the longitudinal evolution of neuropsychiatric symptoms in the post-acute sequelae of COVID-19 (PASC) syndrome and examine symptom treatment at a single center.

Methods

Consecutive participants experiencing persistent neurologic symptoms after acute COVID-19 infection were recruited from October 2020 to July 2022. Data collected included COVID-19 infection history, neurological exam and review of systems, Montreal Cognitive Assessment (MoCA), and self-reported surveys concerning neuropsychiatric symptoms and treatment. Data were collected at baseline and at 1-year follow-up.

Results

A total of 106 participants (mean age 48.6, females 67%) were included in the study. At 1-year follow-up, 72.5% of participants reported at least one neuropsychiatric symptom. Over half (52.5%) of participants reported persistent fatigue. At baseline, 38.8% of all participants had met the established MoCA cut-off score of < 26 for mild cognitive impairment; this decreased to 20.0% at 1 year. COVID-19 infection severity was associated with neuro-PASC symptoms (including fatigue and anxiety) at 1 year. Overall, 29% of participants started at least one new medication for COVID-19-associated neuropsychiatric symptoms. Of the participants who started new medications, fatigue was the most common indication (44.8%) followed by insomnia (27.6%).

Conclusions

Neuropsychiatric symptoms related to neuro-PASC improve over time but can persist for over a year post-recovery. Most treatment modalities targeted neuro-PASC fatigue.
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Metadata
Title
Longitudinal analysis and treatment of neuropsychiatric symptoms in post-acute sequelae of COVID-19
Authors
Emilie N. Liu
Jennifer H. Yang
Lucas Patel
Jasmine Arora
Amanda Gooding
Ronald Ellis
Jennifer S. Graves
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 10/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-023-11885-x

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