Cognitive Neurology Group, Nuffield Department of Clinical Neurosciences and Department of Experimental Psychology, University of Oxford, Oxford, UK.
Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK.
J Alzheimers Dis. 2021;81(1):75-81. doi: 10.3233/JAD-210008.
Acute delirium and other neuropsychiatric symptoms have frequently been reported in COVID-19 patients and are variably referred to as acute encephalopathy, COVID-19 encephalopathy, SARS-CoV-2 encephalitis, or steroid-responsive encephalitis. COVID-19 specific biomarkers of cognitive impairment are currently lacking, but there is some evidence that SARS-CoV-2 could preferentially and directly target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET imaging. We suggest that an inflammatory parainfectious process targeting preferentially the frontal lobes (and/or frontal networks) could be the underlying cause of these shared clinical, neurophysiological, and imaging findings in COVID-19 patients. We explore the biological mechanisms and the clinical biomarkers that might underlie such disruption of frontal circuits and highlight the need of standardized diagnostic procedures to be applied when investigating patients with these clinical findings. We also suggest the use of a unique label, to increase comparability across studies.
急性谵妄和其他神经精神症状在 COVID-19 患者中经常被报道，其表现形式多种多样，包括急性脑病、COVID-19 脑病、SARS-CoV-2 脑炎或类固醇反应性脑炎。目前缺乏 COVID-19 认知障碍的特异性生物标志物，但有一些证据表明，SARS-CoV-2 可能优先且直接靶向额叶，这可通过行为和执行功能障碍、MRI 上额叶灌注不足、EEG 额叶减慢以及 18F-FDG-PET 成像上额叶代谢减少来提示。我们认为，针对额叶（和/或额叶网络）的炎症性副感染过程可能是 COVID-19 患者出现这些共同临床、神经生理学和影像学表现的潜在原因。我们探讨了可能导致额叶回路中断的生物学机制和临床生物标志物，并强调需要在研究这些临床表现的患者时应用标准化的诊断程序。我们还建议使用独特的标签，以提高研究间的可比性。
