“Our results support the growing evidence that there are chronic neuropsychiatric symptoms after COVID-19 infection,” the University of Georgia School of Medicine investigators wrote in the journal Nature.
Dr Elizabeth Rutkowski, MCG, said: “There were a lot of symptoms that we didn’t know early on in the pandemic, but now it is clear that there is a persistent COVID syndrome and a lot of people are affected. neuroscientists, and the study’s respective authors.
COVID-19 and the severity and longevity of neurological problems
The published study reports on preliminary findings from the initial visit of the first 200 patients enrolled in the Georgia COVID-19 Molecular and Neurological Prospective Cohort Study, or CONGA, those recruited averaged about 125 days after testing positive for the COVID-19 virus.
CONGA was established at the MCG at the beginning of the 2020 pandemic to test the severity and longevity of neurological problems and started enrollment in March 2020 with the ultimate goal of recruiting 500 people within 5 years.
- 80% of the first 200 participants reported neurological symptoms accompanied by fatigue, the most common symptom, reported in 68.5%, and headache in the posterior 66.5%.
- Just over half reported changes in smell (54.5%) and taste (54%) and almost half of the participants (47%) met the criteria for mild cognitive impairment, with 30% showing impaired vocabulary and 32% impaired working memory.
- 21% reported confusion, and hypertension was the most common medical condition that participants reported in addition to their bout with COVID-19.
- None of the participants reported a stroke, weakness or loss of control of the muscles involved in speech, and problems with coordination are some of the less commonly reported symptoms.
- 25% met the criteria for depression, and diabetes, obesity, sleep apnea, and a history of depression were associated with those who met the criteria.
- Anemia and a history of depression were associated with 18% of people who met objective criteria for anxiety.
While the findings so far are not surprising and are in line with what other investigators are looking for, Rutkowski says the fact is that the symptoms reported by participants often don’t match up. what objective testing has shown, is surprising. And, it is two-way.
For example, the majority of participants reported changes in taste and smell, but objective examination of both senses did not always match what they reported. The investigators wrote that a higher proportion of those who did not report changes had evidence of functional impairment based on objective measures. Although the reason is uncertain, part of the difference may be a change in the quality of taste and smell rather than a pure impairment, says Rutkowski.
“They eat a chicken sandwich and it tastes like smoke, candles or something, but our taste buds are trying to describe specific flavors like salty and sweet,” says Rutkowski. For example, other people may rely on these senses more, even when they are preparing food, and may notice even a slight change, she says.
Either way, their data and others suggest an ongoing loss of taste and smell after COVID-19, Rutkowski and her colleagues write. The investigators write that many previous reports were based on these types of self-reports, and the discrepancies they found suggest that the approach may not reflect objective dysfunction.
On the other hand, they report that cognitive testing may overestimate the extent of impairment in disadvantaged populations. The first registrants were mostly female, 35.5% were male. They are 44.6 years old on average, nearly 40% are Black, and 7% have been hospitalized with COVID-19. Investigators said black participants were often disproportionately affected.
75% of Black participants and 23.4% of White participants met the criteria for mild cognitive impairment. The findings likely indicate that cognitive tests assess different ethnic groups differently and socioeconomically, psychosocially (issues such as family problems, depression and sexual abuse) and general physical health factors may disproportionately affect Black individuals, the investigators wrote. It can also mean cognitive testing may overestimate clinical impairment in disadvantaged populations, they write.
Black and Hispanic people are considered twice as likely to be hospitalized with COVID-19 and ethnic and racial minorities are more likely to live in areas with higher infection rates. Genetics is also a likely factor that increases the risk of an increased impact of COVID, like having a higher risk of high blood pressure and heart disease earlier and more severely in life.
The focus of CONGA is trying to better understand the increased risk and impact of COVID-19 affecting Blacks, who make up about 33% of the state’s population.
One reason fatigue seems to be a major factor for people with COVID-19 is inflammation levels, the body’s natural response to infection, remains elevated in some people. For example, blood samples taken at the first visit and again at follow-up showed some inflammatory markers that were elevated and persisted in some people.
These and other findings indicate that although the antibodies against the virus themselves may be weakened, persistent inflammation is contributing to some symptoms such as fatigue, she said. She notes that patients with conditions like multiple sclerosis and rheumatoid arthritis, both of which are considered autoimmune conditions, also have high levels of inflammation, which also includes fatigue as a daily symptom. head.
“They’re so fatigued that they can’t breathe, they finish the dishes and feel so nervous, they immediately have to sit down and feel aching muscles like they’ve just run a mile or more,” says Rutkowski.
“There can be some degree of neurological fatigue because the patient also has brain fog,” she said. Some studies have even shown brain volume shrinkage as a result of a mild to moderate illness.
These ongoing, multi-system concerns are why some healthcare facilities have long established COVID-19 clinics as doctors with expertise in the multitude of issues they are dealing with. encounters gathered to examine each patient.
CONGA participants who reported more symptoms and problems were more prone to depression and anxiety. Issues like this as well as mild cognitive impairment and even vocabulary decline can also reflect the long-term isolation COVID-19 has created for many people, Rutkowski said.
“You’re not doing the things you normally do, like hanging out with friends, which bring joy to most people,” says Rutkowski. “On top of that, you could face illness, loss of friends and family, and loss of a job.”
For CONGA, participants self-reported symptoms and answered questions about their general health such as whether they smoked, drank alcohol, exercised, and any medical conditions. who already knew. But they also received an extensive neurological exam to look at underlying factors such as mental state, reflexes, and motor function. They also performed established tests to assess cognitive function with age-adjusted results. They also conducted scale testing at home, where they were asked to determine the smell and ability to taste sweet, sour, bitter, salty, sweet, or tasteless. They also performed blood analysis to look for signs of persistent infection such as markers of inflammation and oxidative stress.
The investigators wrote that neuropsychiatric symptoms were observed during the acute phase of the infection, but an accurate description of how symptoms progressed was needed. And especially for some individuals, the symptoms persist. Even some formerly highly active individuals, who typically work 80 hours a week and exercise daily, may find themselves only able to be active for about an hour a day and stay in bed for hours, says Rutkowski. remaining time.
Investigators are looking for answers as to why and how, and while Rutkowski says she can’t answer all of their questions yet, she can tell them with certainty. make sure they’re not alone or “crazy”.
How can I protect myself from COVID-19 infection?
Rutkowski says: “One of the best things people can do going forward is to stay diligent in avoiding infections, including getting vaccinated or vaccinated to help protect your brain and body from infections. COVID-19 symptoms persist and help protect others from infection. There is evidence that the more times you get infected, the higher your risk of ongoing problems.
Rutkowski notes that their study results may be slightly biased towards a high percentage of ongoing symptoms because the study is likely to appeal to a high percentage of people who are worried about ongoing problems. .
SARS-CoV-2 is thought to have infected the first humans in late 2019 and is a member of the larger group of coronaviruses that are the source of upper respiratory tract infections, such as the common cold, in humans. for several years.
At least part of the reason SARS-CoV-2 is thought to have such a wide-ranging effect is that the virus is known to bind to angiotensin-converting enzyme-2 (ACE2), which is pervasive in the body.
ACE2 has important roles in functions such as regulating blood pressure and inflammation. It is found on nerve cells, the cells lining the nose, mouth, lungs, and blood vessels, as well as the heart, kidneys, and digestive tract. The virus attaches directly to the ACE2 receptor on the cell surface, which functions like a door for the virus to enter.
Experience and research since the onset of COVID-19 have both shown immediate neurological effects that can include loss of taste and smell, brain infections, headaches and, less commonly, seizures and strokes. , damage or death of the nerves. As time goes on, there is growing evidence that problems such as loss of taste and smell, which can become chronic, can become chronic, as well as problems such as brain fog and fatigue, the investigators write. extremes, depression, anxiety and insomnia. Continuity conditions including these and others are now known as “Long Covid.”
The research was supported by grants from the National Institute of Neurological Disorders and Stroke and philanthropic support from the TR Reddy Family Foundation.