Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ann Clin Transl Neurol. 2021 May;8(5):1073-1085. doi: 10.1002/acn3.51350. Epub 2021 Mar 30.
OBJECTIVE: Most SARS-CoV-2-infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non-hospitalized Covid-19 "long haulers". METHODS: This is a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive (SARS-CoV-2 ) and 50 laboratory-negative (SARS-CoV-2 ) individuals) presenting to our Neuro-Covid-19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid-19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient-reported quality of life measures and standardized cognitive assessments. RESULTS: Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS-CoV-2 than SARS-CoV-2 patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS-CoV-2 patients performed worse in attention and working memory cognitive tasks compared to a demographic-matched US population (T-score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). INTERPRETATION: Non-hospitalized Covid-19 "long haulers" experience prominent and persistent "brain fog" and fatigue that affect their cognition and quality of life.
目的:大多数感染 SARS-CoV-2 的个体从未需要住院治疗。然而,有些人会出现长期症状。我们旨在描述非住院 COVID-19“长程”患者的神经系统表现谱。
方法:这是一项前瞻性研究,纳入了 2020 年 5 月至 11 月期间我们神经 COVID-19 诊所就诊的前 100 例连续患者(50 例 SARS-CoV-2 实验室阳性(SARS-CoV-2)和 50 例实验室阴性(SARS-CoV-2)个体)。由于早期大流行期间检测限制,只要符合美国传染病学会 COVID-19 症状标准、从未因肺炎或低氧血症住院且神经系统症状持续超过 6 周的患者,我们就会将其纳入研究。我们记录了神经系统症状的频率,并分析了患者报告的生活质量测量和标准化认知评估结果。
结果:平均年龄为 43.2±11.3 岁,70%为女性,48%接受了远程医疗评估。最常见的合并症是抑郁/焦虑(42%)和自身免疫性疾病(16%)。主要的神经系统表现为:“脑雾”(81%)、头痛(68%)、麻木/刺痛(60%)、味觉障碍(59%)、嗅觉丧失(55%)和肌痛(55%),只有嗅觉丧失在 SARS-CoV-2 患者中更为常见(37/50 [74%] vs. 18/50 [36%];p<0.001)。此外,85%的患者还出现疲劳。疾病发作时间与主观恢复印象之间无相关性。两组患者在认知和疲劳领域的生活质量均受损。与人口统计学匹配的美国人群相比,SARS-CoV-2 患者在注意力和工作记忆认知任务中的表现更差(T 评分分别为 41.5[37,48.25]和 43[37.5,48.75];均 p<0.01)。
结论:非住院 COVID-19“长程”患者会出现明显且持久的“脑雾”和疲劳,这会影响他们的认知和生活质量。
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