长新冠伴认知障碍患者运动皮层中 GABA 能和谷氨酸能兴奋性不足。

Deficient GABABergic and glutamatergic excitability in the motor cortex of patients with long-COVID and cognitive impairment.

机构信息

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.

出版信息

Clin Neurophysiol. 2023 Jul;151:83-91. doi: 10.1016/j.clinph.2023.04.010. Epub 2023 May 10.

DOI:10.1016/j.clinph.2023.04.010

PMID:37210757

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10170904/

Abstract

OBJECTIVE

Attention, working memory and executive processing have been reported to be consistently impaired in Neuro-Long coronavirus disease (COVID). On the hypothesis of abnormal cortical excitability, we investigated the functional state of inhibitory and excitatory cortical regulatory circuits by single "paired-pulse" transcranial magnetic stimulation (ppTMS) and Short-latency Afferent Inhibition (SAI).

METHODS

We compared clinical and neurophysiological data of 18 Long COVID patients complaining of persistent cognitive impairment with 16 Healthy control (HC) subjects. Cognitive status was evaluated by means of the Montreal Cognitive Assessment (MoCA) and a neuropsychological evaluation of the executive function domain; fatigue was scored by the Fatigue Severity Scale (FSS). Resting motor threshold (RMT), the amplitude of the motor evoked potential (MEP), Short Intra-cortical Inhibition (SICI), Intra-cortical Facilitation (ICF), Long-interval Intracortical Inhibition (LICI) and Short-afferent inhibition (SAI) were investigated over the motor (M1) cortex.

RESULTS

MoCA corrected scores were significantly different between the two groups (p = 0.023). The majority of the patients' performed sub-optimally in the neuropsychological assessment of the executive functions. The majority (77.80%) of the patients reported high levels of perceived fatigue in the FSS. RMT, MEPs, SICI and SAI were not significantly different between the two groups. On the other hand, Long COVID patients showed a reduced amount of inhibition in LICI (p = 0.003) and a significant reduction in ICF (p < 0.001).

CONCLUSIONS

Neuro-Long COVID patients performing sub-optimally in the executive functions showed a reduction of LICI related to GABAb inhibition and a reduction of ICF related to glutamatergic regulation. No alteration in cholinergic circuits was found.

SIGNIFICANCE

These findings can help to better understand the neurophysiological characteristics of Neuro-Long COVID, and in particular, motor cortex regulation in people with "brain fog".

摘要

目的

据报道，注意力、工作记忆和执行处理在神经长冠病（COVID）中一直受到损害。基于皮质兴奋性异常的假设，我们通过单“成对脉冲”经颅磁刺激（ppTMS）和短潜伏期传入抑制（SAI）来研究抑制和兴奋皮质调节回路的功能状态。

方法

我们比较了 18 名长期 COVID 患者（因持续认知障碍而抱怨）和 16 名健康对照（HC）受试者的临床和神经生理数据。认知状态通过蒙特利尔认知评估（MoCA）和执行功能域的神经心理学评估来评估；疲劳通过疲劳严重程度量表（FSS）评分。研究了静息运动阈值（RMT）、运动诱发电位（MEP）的振幅、短程皮质内抑制（SICI）、皮质内易化（ICF）、长程皮质内抑制（LICI）和短程传入抑制（SAI）在运动（M1）皮质上的变化。

结果

两组之间 MoCA 校正分数有显著差异（p=0.023）。大多数患者在执行功能的神经心理学评估中表现不佳。大多数（77.80%）患者在 FSS 中报告了高感知疲劳水平。两组间 RMT、MEPs、SICI 和 SAI 无显著差异。另一方面，长冠病患者的 LICI 抑制量减少（p=0.003），ICF 减少（p<0.001）。