重症监护病房和普通病房 COVID-19 幸存者的神经和（神经）心理学后遗症。

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

机构信息

Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.

Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.

出版信息

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

DOI:10.1111/ene.15812

PMID:37010152

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.

摘要

背景与目的

2019 年冠状病毒病（COVID-19）会影响大脑，导致长期的不适。目前缺乏将大脑异常与客观和主观后果相结合的研究。本研究旨在调查入住重症监护病房（ICU）或普通病房的 COVID-19 患者的长期结构性大脑异常、神经和（神经）心理学后果，并比较 ICU 和普通病房患者的长期后果。

方法

本多中心前瞻性队列研究评估了脑异常（3T 磁共振成像）、认知功能障碍（神经心理学测试组合）、神经系统症状、认知主诉、情绪困扰和幸福感（自我报告问卷）在 ICU 和普通病房（非 ICU）幸存者中的情况。

结果

共有 101 名 ICU 和 104 名非 ICU 患者在出院后 8-10 个月参与了研究。与非 ICU 患者相比，ICU 患者脑微出血更多（61% vs. 32%，p<0.001），微出血数量更多（p<0.001）。两组在认知功能障碍、神经系统症状、认知主诉、情绪困扰或幸福感方面均无差异。微出血数量与认知功能障碍无关。在全样本中，41%的患者有认知障碍筛查提示，12%的患者有标准神经心理学测试提示；62%的患者报告有≥3 项认知主诉。分别有 15%、19%和 12%的患者存在临床相关的抑郁、焦虑和创伤后应激评分；28%的患者存在失眠，51%的患者存在严重疲劳。