Center for Cognitive and Molecular Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Psychology, University of New York in Prague, Prague, Czech Republic.
Curr Neuropharmacol. 2022;20(6):1229-1240. doi: 10.2174/1570159X20666211223130228.
The incidence of infections from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent for coronavirus disease 2019 (COVID-19), has dramatically escalated following the initial outbreak in China, in late 2019, resulting in a global pandemic with millions of deaths. Although the majority of infected patients survive, and the rapid advent and deployment of vaccines have afforded increased immunity against SARS-CoV-2, long-term sequelae of SARS-CoV-2 infection have become increasingly recognized. These include, but are not limited to, chronic pulmonary disease, cardiovascular disorders, and proinflammatory-associated neurological dysfunction that may lead to psychological and neurocognitive impairment. A major component of cognitive dysfunction is operationally categorized as "brain fog" which comprises difficulty concentrating, forgetfulness, confusion, depression, and fatigue. Multiple parameters associated with long-term neuropsychiatric sequelae of SARS-CoV-2 infection have been detailed in clinical studies. Empirically elucidated mechanisms associated with the neuropsychiatric manifestations of COVID-19 are by nature complex, but broad-based working models have focused on mitochondrial dysregulation, leading to systemic reductions of metabolic activity and cellular bioenergetics within the CNS structures. Multiple factors underlying the expression of brain fog may facilitate future pathogenic insults, leading to repetitive cycles of viral and bacterial propagation. Interestingly, diverse neurocognitive sequelae associated with COVID-19 are not dissimilar from those observed in other historical pandemics, thereby providing a broad and integrative perspective on potential common mechanisms of CNS dysfunction subsequent to viral infection. Poor mental health status may be reciprocally linked to compromised immune processes and enhanced susceptibility to infection by diverse pathogens. By extrapolation, we contend that COVID-19 may potentiate the severity of neurological/neurocognitive deficits in patients afflicted by well-studied neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. Accordingly, the prevention, diagnosis, and management of sustained neuropsychiatric manifestations of COVID-19 are pivotal health care directives and provide a compelling rationale for careful monitoring of infected patients, as early mitigation efforts may reduce short- and long-term complications.
严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)引起的 2019 年冠状病毒病(COVID-19)感染的发病率在中国 2019 年底首次爆发后急剧上升,导致了一场全球大流行,造成数百万人死亡。尽管大多数感染患者存活下来,并且 SARS-CoV-2 疫苗的快速问世和部署增加了对 SARS-CoV-2 的免疫力,但 SARS-CoV-2 感染的长期后果已日益受到认识。这些后果包括但不限于慢性肺部疾病、心血管疾病和促炎相关的神经功能障碍,这些都可能导致心理和神经认知障碍。认知功能障碍的一个主要组成部分是“脑雾”,其包括注意力不集中、健忘、困惑、抑郁和疲劳。与 SARS-CoV-2 感染的长期神经精神后遗症相关的多个参数在临床研究中已详细描述。与 COVID-19 的神经精神表现相关的经验性阐明的机制本质上很复杂,但广泛的工作模型集中在 线粒体失调上,导致中枢神经系统结构中的代谢活动和细胞生物能量减少。“脑雾”表达的多个潜在因素可能会导致未来的致病侵袭,导致病毒和细菌的反复传播。有趣的是,与 COVID-19 相关的多种神经认知后遗症与其他历史大流行中观察到的后遗症并无不同,从而为病毒感染后中枢神经系统功能障碍的潜在共同机制提供了广泛而综合的视角。心理健康状况不佳可能与免疫过程受损以及对多种病原体的易感性增强互为因果。由此推断,COVID-19 可能会加重患有研究充分的神经退行性疾病(如阿尔茨海默病和帕金森病)患者的神经/神经认知缺陷的严重程度。因此,预防、诊断和管理 COVID-19 的持续神经精神表现是至关重要的医疗保健指令,并为感染患者的仔细监测提供了强有力的理由,因为早期缓解措施可能会减少短期和长期并发症。