Neurological and (neuro)psychological sequelae in intensive care and general ward COVID-19 survivors

Simona Klinkhammer; Janneke Horn; Annelien A Duits; Johanna M A Visser-Meily; Esmée Verwijk; Arjen J C Slooter; Alida A Postma; Caroline M van Heugten; NeNeSCo Study Group

doi:10.1111/ene.15812

Neurological and (neuro)psychological sequelae in intensive care and general ward COVID-19 survivors

Eur J Neurol. 2023 Jul;30(7):1880-1890. doi: 10.1111/ene.15812. Epub 2023 Apr 18.

Authors

Simona Klinkhammer^{1

2}, Janneke Horn^{3

4}, Annelien A Duits^{1

5

6}, Johanna M A Visser-Meily^{7

8

9}, Esmée Verwijk^{4

10

11}, Arjen J C Slooter^{8

12

13}, Alida A Postma^{14

15}, Caroline M van Heugten^{1

2

16}; NeNeSCo Study Group

Affiliations

¹ Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
² Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.
³ Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁶ Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁷ Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
⁹ Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
¹⁰ Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹¹ Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
¹² Department of Psychiatry and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
¹³ Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Jette, Brussels Health Campus, Belgium.
¹⁴ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁵ Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
¹⁶ Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.

PMID: 37010152
DOI: 10.1111/ene.15812

Abstract

Background and purpose: Coronavirus disease 2019 (COVID-19) affects the brain, leading to long-term complaints. Studies combining brain abnormalities with objective and subjective consequences are lacking. Long-term structural brain abnormalities, neurological and (neuro)psychological consequences in COVID-19 patients admitted to the intensive care unit (ICU) or general ward were investigated. The aim was to create a multidisciplinary view on the impact of severe COVID-19 on functioning and to compare long-term consequences between ICU and general ward patients.

Methods: This multicentre prospective cohort study assessed brain abnormalities (3 T magnetic resonance imaging), cognitive dysfunction (neuropsychological test battery), neurological symptoms, cognitive complaints, emotional distress and wellbeing (self-report questionnaires) in ICU and general ward (non-ICU) survivors.

Results: In al, 101 ICU and 104 non-ICU patients participated 8-10 months post-hospital discharge. Significantly more ICU patients exhibited cerebral microbleeds (61% vs. 32%, p < 0.001) and had higher numbers of microbleeds (p < 0.001). No group differences were found in cognitive dysfunction, neurological symptoms, cognitive complaints, emotional distress or wellbeing. The number of microbleeds did not predict cognitive dysfunction. In the complete sample, cognitive screening suggested cognitive dysfunction in 41%, and standard neuropsychological testing showed cognitive dysfunction in 12%; 62% reported ≥3 cognitive complaints. Clinically relevant scores of depression, anxiety and post-traumatic stress were found in 15%, 19% and 12%, respectively; 28% experienced insomnia and 51% severe fatigue.

Conclusion: Coronavirus disease 2019 ICU survivors had a higher prevalence for microbleeds but not for cognitive dysfunction compared to general ward survivors. Self-reported symptoms exceeded cognitive dysfunction. Cognitive complaints, neurological symptoms and severe fatigue were frequently reported in both groups, fitting the post-COVID-19 syndrome.

Keywords: COVID-19; ICU; SARS-CoV-2; affective; brain damage; cognitive; neurological; neuropsychological.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
Cerebral Hemorrhage
Critical Care
Depression / epidemiology
Fatigue / etiology
Humans
Intensive Care Units
Patients' Rooms
Post-Acute COVID-19 Syndrome
Prospective Studies
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / etiology
Survivors / psychology