TY - JOUR
AU - Ross Russell, Amy L
AU - Hardwick, Marc
AU - Jeyanantham, Athavan
AU - White, Laura M.
AU - Deb, Saumitro
AU - Burnside, Girvan
AU - Joy, Harriet M.
AU - Smith, Craig J.
AU - Pollak, Thomas A.
AU - Nicholson, Timothy R.
AU - Davies, Nicholas W.S.
AU - Manji, Hadi
AU - Easton, Ava
AU - Ray, Stephen
AU - Zandi, Michael S.
AU - Coles, Jonathan P.
AU - Menon, David K.
AU - Varatharaj, Aravinthan
AU - McCausland, Beth
AU - Ellul, Mark A.
AU - Thomas, Naomi
AU - Breen, Gerome
AU - Keddie, Stephen
AU - Lunn, Michael P.
AU - Burn, John P.S.
AU - Quattrocchi, Graziella
AU - Dixon, Luke
AU - Rice, Claire M
AU - Pengas, George
AU - Salman, Rustam Al-Shahi
AU - Carson, Alan
AU - Joyce, Eileen M.
AU - Turner, Martin R
AU - Benjamin, Laura A.
AU - Solomon, Tom
AU - Kneen, Rachel
AU - Pett, Sarah
AU - Thomas, Rhys Huw
AU - Michael, Benedict D.
AU - Galea, Ian
PY - 2021
DA - July
TI - Spectrum, risk factors, and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study
JO - Brain Communications
VL - 3
IS - 3
DO - https://doi.org/10.1093/braincomms/fcab168
AB - SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome.A prioriclinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n= 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients &lt;60 years. Relative to those &gt;60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials.
PB - Oxford University Press
UR - https://www.research.ed.ac.uk/en/publications/8738730d-fe3c-4aa5-ba21-55653b8d3edc
KW - Coronavirus (COVID-19)
KW - Mental health and wellbeing
ER