Bereczki Dániel, Dénes Ádám, Boneschi Filippo M, Akhvlediani Tamar, Cavallieri Francesco, Fanciulli Alessandra, Filipović Saša R, Guekht Alla, Helbok Raimund, Hochmeister Sonja, von Oertzen Tim J, Özturk Serefnur, Priori Alberto, Rakusa Martin, Willekens Barbara, Moro Elena, Sellner Johann
Department of Neurology, Semmelweis University, Budapest, Hungary.
HUN-REN SU Neuroepidemiology Research Group, Budapest, Hungary.
J Neurol. 2025 May 6;272(6):380. doi: 10.1007/s00415-025-13110-3.
Neuropathological and clinical studies suggest that infection with SARS-CoV-2 may increase the long-term risk of neurodegeneration.
We provide a narrative overview of pathological and clinical observations justifying the implementation of a surveillance program to monitor changes in the incidence of neurodegenerative disorders in the years after COVID-19.
Autopsy studies revealed diverse changes in the brain, including loss of vascular integrity, microthromboses, gliosis, demyelination, and neuronal- and glial injury and cell death, in both unvaccinated and vaccinated individuals irrespective of the severity of COVID-19. Recent data suggest that microglia play an important role in sustained COVID-19-related inflammation, which contributes to the etiology initiating a neurodegenerative cascade, to the worsening of pre-existing neurodegenerative disease or to the acceleration of neurodegenerative processes. Histopathological data have been supported by neuroimaging, and epidemiological studies also suggested a higher risk for neurodegenerative diseases after COVID-19.
Due to the high prevalence of COVID-19 during the pandemic, healthcare systems should be aware of, and be prepared for a potential increase in the incidence of neurodegenerative diseases in the upcoming years. Strategies may include follow-up of well-described cohorts, analyses of outcomes in COVID-19-registries, nationwide surveillance programs using record-linkage of ICD-10 diagnoses, and comparing the incidence of neurodegenerative disorders in the post-pandemic periods to values of the pre-pandemic years. Awareness and active surveillance are particularly needed, because diverse clinical manifestations due to earlier SARS-CoV-2 infections may no longer be quoted as post-COVID-19 symptoms, and hence, increasing incidence of neurodegenerative pathologies at the community level may remain unnoticed.
神经病理学和临床研究表明，感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能会增加神经退行性变的长期风险。
我们对病理和临床观察进行了叙述性概述，证明有必要实施一项监测计划，以监测2019冠状病毒病（COVID-19）后数年神经退行性疾病发病率的变化。
尸检研究显示，无论COVID-19的严重程度如何，未接种疫苗和接种疫苗的个体大脑均出现了多种变化，包括血管完整性丧失、微血栓形成、胶质细胞增生、脱髓鞘以及神经元和神经胶质损伤及细胞死亡。最近的数据表明，小胶质细胞在持续的COVID-19相关炎症中起重要作用，这有助于引发神经退行性级联反应的病因、使既往神经退行性疾病恶化或加速神经退行性进程。组织病理学数据得到了神经影像学的支持，流行病学研究也表明COVID-19后神经退行性疾病的风险更高。
由于大流行期间COVID-19的高流行率，医疗保健系统应意识到并为未来几年神经退行性疾病发病率的潜在增加做好准备。策略可能包括对详细描述的队列进行随访、分析COVID-19登记处的结果、使用国际疾病分类第10版（ICD-10）诊断的记录链接进行全国性监测计划，以及将大流行后时期神经退行性疾病的发病率与大流行前年份的值进行比较。尤其需要提高认识和进行主动监测，因为早期SARS-CoV-2感染引起的各种临床表现可能不再被视为COVID-19后症状，因此，社区层面神经退行性病变发病率的增加可能仍未被注意到。
