Cognitive disorders associated with risk for developing severe COVID-19

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Cognitive disorders associated with risk for developing severe COVID-19

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Cognitive disorders associated with risk for developing severe COVID-19

10/28/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


Dementia and other cognitive disorders now appear to be risk factors for developing severe COVID-19, according to research from the University of Georgia. The findings highlight the need for special care for populations with these preexisting conditions during the pandemic.

In a blind study, the researchers analyzed data from nearly 1,000 diseases and two specific genes to compare the health profiles of COVID-19 patients with those testing negative, looking for commonalities in the COVID-19 patients.

The study, published online in the journal Brain, Behavior and Immunity, relied on data from UK Biobank, a long-term study of more than 500,000 participants investigating the respective contributions of genetic predisposition and environmental exposure to the development of disease.

Beginning in March, the UK Biobank started to report the COVID-19 status of its participants. The team in the Franklin College of Arts and Sciences department of genetics, led by assistant professor Kaixiong Ye and his postdoc, Jingqi Zhou, promptly connected the COVID-19 status to the electronic health data.

" We took a hypothesis-free approach and the most statistically significant ones are the cognitive disorders and Type 2 diabetes. Right now, we don't know the mechanisms behind these associations, we only know these are more common in COVID-19 patients."

- Kaixiong Ye, senior author on the study

Analyzing the genetic factors that make some individuals at higher risk for severe COVID-19, the team focused on two genes: ACE2 and TPMPRSS2, known to be critical for the virus to enter into human cells.

"In the TMPRSS2 gene we found that a specific genetic variation is more common in the COVID-19 patient," he said, adding that while the discovery was novel at the time, the team knows more data now exists about host genetic factors than even three months ago.

The research team also found that variations in genes related to SARS-CoV-2 infection may be associated with severe COVID-19 that requires hospitalization.

"And we are starting to understand how those genetic variations are making a difference," he said, noting the extraordinary pace of research worldwide during the pandemic as scientists work on SARS CoV 2. Since they began in spring 2020, Ye's group has been able to follow up on its own earlier work and communicate with peers around the world to contribute to the overall body of knowledge about the disease.

"Working on one disease, the whole field is converging together, around the world, at the same time. It really showcases the power of science," Ye said. "What my group is doing is really just data analysis, large-scale data mining, but from vaccine development to studies in patients, scientists are attacking the disease from different aspects, and that's moving us forward very quickly in combating COVID-19."

Source:

University of Georgia

Journal reference:

Zhou, J., et al. (2020) Cognitive disorders associated with hospitalization of COVID-19: Results from an observational cohort study. Brain, Behavior, and Immunity. doi.org/10.1016/j.bbi.2020.10.019.
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Delirium in older patients with COVID-19

11/19/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


Delirium is common in older patients admitted to US emergency departments with COVID-19 infection, according to the findings of a new study.


Additionally, patients presenting this symptom were more likely to have poor hospital outcomes or die.

Elderly at greater risk of dying from COVID-19 complications


Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in late December 2019, there have been over 56.3 million confirmed infections and 1.35 million lives lost globally. While people of all ages can contract and become ill with the virus, a growing body of evidence shows that some demographics are at an increased risk of suffering severe symptoms of the disorder, becoming hospitalized, and dying from complications.

Recent data demonstrate that the elderly (those aged 65 or over) is one of these at-risk populations. In the US, those aged 65 or over account for a huge 80% of COVID-19 related deaths. The fact that this age group makes up just 16% of the US population highlights the disproportional representation of the elderly in COVID mortalities.

Delirium is a cognitive symptom characterized by a serious disturbance in mental abilities, resulting in confused thinking and significantly reduced awareness of the environment. Studies have shown that delirium is being increasingly presented by elderly patients admitted to emergency departments.

Unfortunately, research has also highlighted that emergency physicians often fail to recognize and diagnose delirium or fail to recognize the true importance of a diagnosis of delirium.

Since the pandemic was declared in March of 2020, much data has been collected to gain a deeper understanding of the nature of COVID-19 to prevent its transmission and improve the outcomes for those hospitalized with infections.

Previously, anecdotal evidence had suggested that elderly patients present different symptoms to those of the general population when admitted to hospital with COVID-19 infection. Part of this anecdotal evidence hinted that delirium was commonly presented in elderly patients hospitalized with COVID-19.

As delirium is not a common symptom of COVID-19 within the general population, researchers recognized the value of collecting data on its occurrence in the elderly to better understand how COVID-19 impacts this population.

Assessing the frequency of delirium in elderly COVID-19 patients


In a paper published this month in the journal JAMA Network Open, a team of researchers describes how they conducted their study to determine how frequently delirium is presented by older adults hospitalized with COVID-19, and how this impacts their hospital outcomes.

The team collected data from seven sites across the US, assessing a total of 817 patients with a mean age of 77.7 years. Of these patients, 28% presented delirium upon arrival at the hospital.

Additionally, among this group, delirium was the sixth most common symptom of COVID-19 infection. Among those patients diagnosed with delirium, 37% presented no typical COVID-19 symptoms or signs, including fever or shortness of breath.

Enhancing hospital outcomes for elderly COVID-19 patients

The study demonstrates the need to equip emergency staff with the skills to recognize symptoms of delirium in the elderly, particularly in those admitted with COVID-19 infections. It also reveals that symptoms of COVID-19 may differ across populations.

Results showed that it was not uncommon for elderly patients with COVID-19 to display no common symptoms while often presenting with delirium. Moving forward, to enhance hospital outcomes for elderly COVID-19 patients, further studies must be conducted to determine if delirium is preventable in this cohort and what intervention strategies would be effective in protecting the elderly from developing the cognitive syndrome.

Further research is also required to understand how the severity and duration of delirium presented by elderly COVID-19 patients could be reduced.
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COVID-19 ICU patients found to have higher burden of delirium and coma

1/8/21


https://www.news-medical.net/news/20210 ... -coma.aspx


COVID-19 patients admitted to intensive care in the early months of the pandemic were subject to a significantly higher burden of delirium and coma than is typically found in patients with acute respiratory failure. Choice of sedative medications and curbs on family visitation played a role in increasing acute brain dysfunction for these patients.

That's according to an international study published Jan. 8 in The Lancet Respiratory Medicine, led by researchers at Vanderbilt University Medical Center in coordination with researchers in Spain.

The study, which is far the largest of its kind to date, tracks the incidence of delirium and coma in 2,088 COVID-19 patients admitted before April 28, 2020, to 69 adult intensive care units across 14 countries.

ICU delirium is associated with higher medical costs and greater risk of death and long-term ICU-related dementia. Seminal studies at VUMC over the past two decades have spurred widespread interest in ICU delirium research, and the resulting body of evidence has come to inform critical care guidelines endorsed by medical societies in several countries.

These guidelines include well calibrated pain management with prompt discontinuation of analgesics and sedatives, daily spontaneous awakening trials, daily spontaneous breathing trials, delirium assessments throughout the day, early mobility and exercise, and family engagement.

Some 82% of patients in this observational study were comatose for a median of 10 days, and 55% were delirious for a median of three days. Acute brain dysfunction (coma or delirium) lasted for a median of 12 days.

"This is double what is seen in non-COVID ICU patients," said VUMC's Brenda Pun, DNP, RN, co-first author on the study with Rafael Badenes MD, PhD, of the University of Valencia in Spain. The authors cite a previous large, multi-site ICU study, also led by VUMC, where acute brain dysfunction lasted a median of five days, including four days of coma and one day of delirium.

The authors note that COVID-19 disease processes could predispose patient to a higher burden of acute brain dysfunction. But they also note that a number of patient care factors, some of which are related to pressures posed on health care by the pandemic, also appear to have played a significant role.

The study appears to show a reversion to outmoded critical care practices, including deep sedation, widespread use of benzodiazepine infusions (benzodiazepine is a nervous system depressant), immobilization, and isolation from families. The authors find that, where COVID-19 is concerned, there has been an apparent widespread abandonment of newer clinical protocols that are proven to help ward off the acute brain dysfunction that stalks many critically ill patients.


" It is clear in our findings that many ICUs reverted to sedation practices that are not in line with best practice guidelines, and we're left to speculate on the causes. Many of the hospitals in our sample reported shortages of ICU providers informed about best practices. There were concerns about sedative shortages, and early reports of COVID-19 suggested that the lung dysfunction seen required unique management techniques including deep sedation. In the process, key preventive measures against acute brain dysfunction went somewhat by the boards."

- Brenda Pun, DNP, RN, Study's Co-First Author

Using electronic health records, investigators were able to closely examine patient characteristics, care practices and findings from clinical assessments. Some 88% of patients tracked in the study were invasively mechanical ventilated at some point during hospitalization, 67% on the day of ICU admission. Patients receiving benzodiazepine sedative infusions were at 59% higher risk of developing delirium. Patients who received family visitation (in-person or virtual) were at 30% lower risk of delirium.

"There's no reason to think that, since the close of our study, the situation for these patients has changed," said one of the study's senior authors, Pratik Pandharipande, MD, MSCI, professor of Anesthesiology.

"These prolonged periods of acute brain dysfunction are largely avoidable. Our study sounds an alarm: as we enter the second and third waves of COVID-19, ICU teams need above all to return to lighter levels of sedation for these patients, frequent awakening and breathing trials, mobilization and safe in-person or virtual visitation."

Source:

Vanderbilt University Medical Center
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People with dementia found to have significantly increased risk for COVID-19

2/9/21


https://www.news-medical.net/news/20210 ... ID-19.aspx


A study led by Case Western Reserve University researchers found that patients with dementia were at a significantly increased risk for COVID-19-;and the risk was higher still for African Americans with dementia.

Reviewing electronic health records of 61.9 million adults in the United States, researchers found the risk of contracting COVID-19 was twice as high for patients with dementia than for those without it-;while among those with dementia, African Americans had close to three times the risk of being infected with COVID-19 as Caucasians did.

In addition, patients with dementia who contracted COVID-19 had significantly worse outcomes in terms of hospitalizations and deaths than those who had COVID-19 but not dementia.

The study was published Feb. 9 by the peer-reviewed Alzheimer's & Dementia: The Journal of the Alzheimer's Association and highlights the need to protect people with dementia-;particularly African Americans-;as part of the strategy to control the pandemic.

An estimated 5.8 million Americans age 65 and older and 50 million people worldwide are living with Alzheimer's and other dementias, according to the Alzheimer's Association.

" Our results emphasize how important it is to protect those with dementia from acquiring SARS-CoV2, for they are at higher risk for severe disease than those without dementia. These patients may constitute another vulnerable category. However, more work is required to understand the mechanism by which this occurs."

- Pamela Davis, study co-author, dean emerita, Case Western Reserve School of Medicine

The study's authors also include two other members of the School of Medicine: Rong Xu, principal investigator on the research and a professor of biomedical informatics and director of the Center for Artificial Intelligence in Drug Discovery, and QuanQiu Wang, a specialist in artificial intelligence. Co-author Mark Gurney is founder and CEO of Tetra Therapeutics, a drug development company focused on brain disorders and injuries based in Grand Rapids, Michigan, and a wholly-owned subsidiary of Shionogi & Co., Ltd.

They hypothesized the risk of COVID-19 would be greater for patients with dementia for several reasons, including: People with dementia may be more susceptible to contracting COVID-19 because of blood-brain barrier damage that can allow certain viruses and bacteria to reach the brain more easily.

In addition, dementia may interfere with a person's ability to wear a mask, physically distance from others or frequently clean their hands. Moreover, conditions such as cardiovascular diseases, diabetes, obesity and hypertension are risk factors for both dementia and COVID-19 and are associated with worse outcomes.

"On behalf of the millions of people living with Alzheimer's and other dementia that we represent, these preliminary findings suggest a frightening reality of the vulnerabilities associated with dementia," said Maria Carrillo, PhD, Alzheimer's Association chief science officer. "It is critical we develop and implement strategies that strike a balance between keeping people, especially long-term care residents, safe from COVID-19 but also protecting them from health-related harms associated with social isolation."

Researchers examined electronic health records (stripped of identifying information) from 360 hospitals and 317,000 providers nationally, representing 20% of the U.S. population. Of the 61.9 million adults in the study population, more than one million had dementia, 15,770 had COVID-19 and 810 had both.

"The availability of such a large de-identified database of patient electronic health records analyzed by modern informatics techniques gave our study great power to detect vulnerabilities in patient disease groupings," Xu said.

The researchers also adjusted the data to account for factors including age, gender, race, other health conditions and whether individuals lived in a nursing home. They used an adjusted odds ratio to determine risk.

Their findings:

While overall the odds of contracting COVID-19 were twice as high for patients with dementia compared to those without dementia, the risk varied by condition. Patients with vascular dementia had the highest risk-;with odds more than three times higher-; followed by patients with presenile dementia, senile dementia, Alzheimer's disease and post-traumatic dementia.

The odds of African Americans with dementia contracting COVID-19 were almost three times higher than for Caucasians with dementia. Generally, gender had no additional effects on the risk of COVID-19 in patients with dementia, while age had no additional effects in patients with dementia in general and Alzheimer's specifically.

The overall hospitalization risk during the six months for adults with COVID-19 was 25.17%. But among patients with COVID-19 and dementia, 59.26% were hospitalized, and the percentage was even higher-;73.08%-; among African American patients, compared to 53.85% of Caucasians with both conditions.

he overall mortality risk for patients with COVID-19 was 5.64%. But among those who also had dementia, 20.99% died, with the percentage higher for African Americans (23.08%) than for Caucasians (19.23%).

Source:

Case Western Reserve University

Journal reference:

Wang QQ, Davis PB, Gurney ME, Xu R. COVID‐19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US. Alzheimer's Dement. 2021; 1– 10. https://doi.org/10.1002/alz.12296
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Duration of delirium in critically ill patients predicts mortality and disability

2/11/21


https://www.news-medical.net/news/20210 ... ility.aspx


Delirium, a form of acute brain dysfunction, is widespread in critically ill patients in lower resourced hospitals, and the duration of delirium predicted both mortality and disability at six months after discharge, according to a study published in PLOS ONE.

Working with partners in Zambia, Vanderbilt University Medical Center researchers evaluated 711 hospitalized critically ill patients; delirium occurred in 48.5%. The findings shed light on the impact of delirium on a patient's recovery -- and even whether a patient is likely to live or die.

There have been limited data on the prevalence and outcomes of delirium in low- and middle-income countries, despite there being high numbers of critically ill patients. The mitigation of delirium and post-acute support of patients with delirium is a growing public health concern in the U.S. and Europe as the number of patients in intensive care units surged with the rise of COVID-19 cases.

" There is a driving unmet need to understand what happens with people's brains in critical illness in low- and middle- income countries as well as with HIV in all settings. The necessity is now urgent because of the COVID-19 pandemic. Delirium has become the epidemic within the pandemic -- and it's the strongest predictor of long-term acquired cognitive impairment after critical illness. These are bread and butter issues people care about: will I live or die and if I live, what will I be like as a person."

- Wesley Ely, MD, MPH, Co-Director, Critical Illness, Brain Dysfunction, and Survivorship Center, VUMC and Senior Author

Patients with delirium had a higher six-month mortality, 44.6%, than patients without delirium who had a 20.0% six-month mortality. Compared to no delirium, presence of 1, 2 or 3 days of delirium predicted higher odds of six-month mortality of 1.43, 2.20, and 3.92, respectively. A similar relationship was found between duration of delirium and odds of worse six-month disability, assessed using the WHO Disability Assessment Schedule.

The study adjusted for age, sex, education, income, Universal Vital Assessment (UVA) severity of illness score, HIV status, and current antituberculosis treatment in adult patients who spoke English, Nyanja, or Bemba at the University Teaching Hospital, a 1,655-bed national referral hospital in Lusaka with about 17,500 acute admissions annually.

The prevalence of HIV in the study cohort was 45.4% while 27.2% of participants had a history of tuberculosis, suggesting delirium is an important clinical issue impacting the lives of hospitalized patients with HIV and tuberculosis in Sub-Saharan Africa. The high mortality and disability associated with delirium in this medically and socioeconomically vulnerable patient population spotlights an urgent global health issue.

"Acute brain dysfunction can have a variety of drivers, yet we know that delirium can itself lead to poor outcomes. In other parts of the world delirium is recognized as a major public health concern, while in lower resourced communities the magnitude of the problem has been obscured by acutely pressing issues such as HIV, malaria, and tuberculosis.

Our research suggests it's widespread and may present an opportunity to improve the lives of critically ill patients in low- and middle-income countries in the future as well as advocate for global critical care equity during the COVID-19 pandemic," said Justin Banerdt, MD, MPH, internal medicine resident at Yale School of Medicine, and corresponding author who led the study on the ground in Zambia while a MD/MPH student at Vanderbilt University School of Medicine.

The next step is to see which interventions are effective in resource limited hospitals, said Douglas Heimburger, MD, MS, professor of Medicine and core faculty at the Vanderbilt Institute for Global Health. He leads projects with grant funding from the Fogarty International Center of the National Institutes of Health (NIH).

"I'm glad for the opportunity to bring attention to the implications that delirium has on patients and communities with solid evidence. The takeaway is that delirium needs to be treated alongside the underlying and driving issue. It's an important message that needs to be a call to action so we can save and improve more lives," said Heimburger.

Source:

Vanderbilt University Medical Center
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New report identifies key barriers and enablers for data sharing in dementia research

2/23/21


https://www.news-medical.net/news/20210 ... earch.aspx


At an online European Parliament workshop hosted by Deirdre Clune MEP (Ireland), Alzheimer Europe launched a new report "Data Sharing in Dementia Research", which reviews recent changes in EU research policy and sets out recommendations to improve data sharing in dementia research.

In this report, Alzheimer Europe evaluates the legal and policy landscapes that dementia researchers have had to navigate since the launch of Horizon 2020 in 2013. The report identifies key barriers and enablers for data sharing. It maps the Horizon 2020 dementia research portfolio, assessing the scale of EU investment in dementia research and the use of clinical research data. Finally, it reviews recent surveys of researchers, research participants and patients, collating their perceptions and concerns regarding data sharing.

Key findings:


To date, over EUR 570 million has been invested through Horizon 2020 in dementia research projects, many of which involve the use of clinical data
Although Open Access principles have been widely adopted, the uptake of Open Data practices varies between sectors and Member States
The General Data Protection Regulation (GDPR) has not yet fully delivered on its aim of facilitating research data sharing, due to a perceived lack of clarity and regulatory divergence between Member States
Researchers face technical, financial and motivational obstacles to data sharing, with the loss of privacy being the most frequently-cited concern for research participants.

Key recommendations to improve data sharing:


Developing pathways for faster, secure sharing of research data between sectors and across borders, including GDPR codes of conduct and standard contract clauses
Supporting researchers to maintain datasets and platforms after projects end, and embedding academic reward systems that place a greater value on data sharing and transparency
Increasing digital literacy in the general population, ensuring that older adults and vulnerable groups are not left behind
Involving people with dementia in the design and conduct of research, as well as in data governance.

Commenting on the launch of the report, Alzheimer Europe's Executive Director, Jean Georges, stated:

"The number of people with dementia in Europe is likely to double by 2050, increasing from 9.78 to 18.8 million in the wider European region. Unfortunately, research on dementia has historically received proportionately less funding than other disease areas. As a result, there is an urgent need to maximise the utility of data from dementia research. Data sharing represents an important step towards meeting this need, and could help increase our understanding of the causes, treatment, prevention and care of dementia. However, there is still much to do to improve data sharing in dementia research. To ensure people with dementia benefit from the progress made in recent years, we need to work together to overcome the remaining obstacles to data sharing, and maintain dementia research as a priority for EU research programmes."

Source:

Alzheimer Europe
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Study demonstrates long-term neuropsychological consequences following SARS-CoV-2 infection

3/2/21


https://www.news-medical.net/news/20210 ... ction.aspx


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the coronavirus disease (COVID-19), causes a wide range of symptoms beyond the respiratory tract.

Many patients report many symptoms impacting the cardiovascular system and the nervous system. There is growing evidence that SARS-CoV-2 infection can include long-term neuropsychological deficits, even in its mild or moderate respiratory forms.

A team of researchers at the Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, the University of Geneva in Switzerland, reports that SARS-CoV-2 may affect the central nervous system, particularly the limbic system responsible for behavioral and emotional responses.

The study, published in the pre-print server medRxiv*, demonstrates the presence of long-lasting neuropsychological sequelae after COVID-19, regardless of the respiratory disease's severity.

Study background

Health experts have suspected the presence of long-term neuropsychological deficits after SARS-C0V-2 infection. For instance, previous studies about the two previous coronavirus outbreaks, the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), demonstrated the presence of neuropsychological symptoms like sleep disorders, emotional lability, impaired concentration, frequent recall of traumatic experiences, impaired memory, and fatigue in more than 15 percent of affected patients about one month to 3.5 years following infection.

Further, in other diseases like the Human Immunodeficiency Virus (HIV), encephalitis, and multiple sclerosis, studies have shown specific long-term deficits in cognitive functions, including emotional responses and memory,

In COVID-19, however, there are reports of increased prevalence of stroke in patients, leading to additional short-and long-term neurological and cognitive deficits. Lastly, the sudden onset of anosmia or the loss of smell has been described as a symptom in COVID-19 patients.

This symptom happens because olfactory epithelium carries angiotensin-converting enzyme 2 (ACE2) receptors, the cellular gateway the virus uses to enter human cells. Scientists formulated that the virus may have used the nose-brain barrier for viral entry.

The study

The current study aims to determine the effect of SARS-CoV-2 infection on the brain. The team wants to investigate whether COVID-19 causes long-term neuropsychological deficits from 6 to 9 months, identify the nature of the affected domains, and know the impact of these deficits on the patient's quality of life.

The team administered standardized neuropsychological, neurological, psychiatric, and olfactory tests to 45 patients to arrive at the study findings.

The team divided the patients into three groups, according to the severity of the respiratory disease in the acute phase: severe, moderate, or mild. Severe cases were admitted in the intensive care unit with respiratory assistance, moderate cases were hospitalized without respiratory aid, and mild patients were not admitted to the hospital.

The researchers found a high prevalence of psychiatric symptoms, regardless of disease severity, in the illness's acute phase. Patients in all three groups manifested depressive symptoms, mania, anxiety, stress, apathy, post-traumatic stress disorder (PTSD), and dissociative disorders. Some patients reported insomnia, fatigue, and pathological somnolence.

When it comes to the sense of smell, 33.33 percent of the mild group, 73.33 percent of the moderate group, and 46.66 percent of the severe group have hyposmia or the partial loss of smell six to nine months after being infected. Meanwhile, of the severe group, 13.33 percent still had anosmia or the complete loss of smell.

Though the cognitive deficits reported in the three groups were common, some domains of cognition and mood were impacted differently, depending on the disease's severity. In long-term episodic memory, the severe group patients performed more poorly than the mild group. They also showed more anosognosia for memory dysfunction.

Meanwhile, the mild group was more stressed, anxious, depressed, and reported more cognitive issues. The moderate group recognized multimodal emotions less well than the mild group. All of these manifestations have impacted the patients' lives.

"At this stage, it is difficult to determine whether the cognitive deficits can be regarded as a marker of brain damage and/or should be linked to psychiatric variables that may themselves result directly from infection with SARS-CoV-2 or else be triggered by the stressful nature of the general pandemic and the individual experience of the disease," the researchers explained.

The team recommends that clinical guidelines and recommendations should be implemented in the management of long-term neurological impairment after SARS-CoV-2 infection


*Important Notice


medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Long COVID neuropsychological deficits after severe, moderate or mild infection, P. Voruz, G. Allali, L. Benzakour, A. Nuber-Champier, M. Thomasson, I. Jacot, J. Pierce, P. Lalive, K-O. Lövblad, O. Braillard, M. Coen, J. Serratrice, J. Pugin, R. Ptak, I. Guessous, B.N. Landis, F. Assal, J.A. Péron, medRxiv, 2021.02.24.21252329; doi: https://doi.org/10.1101/2021.02.24.21252329, https://www.medrxiv.org/content/10.1101 ... 21252329v1
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Researchers conduct large meta-analysis of COVID-19’s neurological manifestations

3/3/21

https://www.news-medical.net/news/20210 ... tions.aspx


The global spread of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to intense interest in the various manifestations of the infection, including its neurological features. A compact summation by researchers across the UK of what is known at present about this facet of the disease is presented in a new paper, which has been released on the medRxiv* preprint server­.

Many earlier reports have been small and retrospective in design, reflecting the need to obtain some early information in the face of a rapidly spreading viral infection. These were succeeded by larger multicenter prospective studies that are currently underway.

The current paper details the team’s aim to bring out a new platform that will allow this area of the pandemic disease to be assessed and revised in real-time. Beginning in May 2020, the researchers reviewed all kinds of relevant scientific literature dealing with neurological symptoms, associated clinical features, and potential pathogenetic mechanisms in the form of a weekly blog.

This blog is called “The neurology and neuropsychiatry of COVID-19” and appears on the Journal of Neurology, Neurosurgery and Psychiatry website. Taking their work one step later, the researchers compiled the evidence as a systematic review and meta-analysis, termed “Systematically Analyse and Review Studies of COVID-19 Neurology and neuropsychiatry” (SARS-COVNeuro).

Methodology of early literature in this field


The most common study type was case series. When classified by the beginning of data collection, they found that 65 and 115 studies were ‘early’ and ‘late.’ These began to collect data between December 2019 and February 2020, and between March 2020 and July 2020, respectively.

Of the early studies, 57% were case series, but only 35% of later studies. Most are single-center studies and involve hospitalized patients in above half and two-thirds of early and late studies, respectively.

There were 18 studies with a thousand or more participants. Altogether, there were over 1,00,000 participants. High-quality studies made up only 11% of the total, with 46% being moderate and 44% low quality.

The first cohort study appeared at least two months after the initial outbreak of SARS-CoV-2 in Wuhan, China. Overall, the studies come from China, the USA, Italy and France, with China being by far the largest contributor.

Early prevalence of neurological complications in COVID-19


The meta-analysis included 20 or more neurological or related manifestations described by three or more studies. Altogether, this included 147 studies, with almost 1,00,000 patients.

The most commonly studied symptoms included headache, muscle pain, tiredness, anosmia, and dysgeusia, all of which were mentioned in 52 to 84 studies. The most commonly reported symptoms were similar.

However, the order of prevalence was, in descending order, anosmia, weakness, tiredness, dysgeusia and muscle pain. These were reported to be present in 43% of patients, for anosmia, down to 25% for myalgia.

Inter-study variability ranged from very high (over 90%) for 13 of these symptoms to less than 50% for five manifestations. Many studies merely recorded the presence or absence of these symptoms.

Depression and anxiety were reported in 23% and 16%, respectively, indicating their high prevalence. Strokes and seizures were much less common, at 2.3% and 006%, respectively.

Among the subgroups, the researchers found headache, myalgia, anosmia and dysgeusia have been reported at much higher rates in prospective compared to retrospective studies. When analyzed by clinical severity, the study reports a higher prevalence of headache, myalgia, dysgeusia and anosmia in less severe patient groups.

What are the implications?


In this largest of all available systematic reviews of the neurological manifestations of COVID-19, the researchers found that most of the symptoms were non-specific, indicating the systemic nature of the illness. Specific symptoms relating to the nervous system, such as seizures, altered mental status, depression and anxiety, and sleep disorders, were not studied as frequently.

While depression and anxiety were less studied, their prevalence was high. Organic diseases, such as strokes and seizures, were much less common.

The researchers indicate that the design of the study, as well as the severity of the disease and the country where the study was carried out, affect the frequency with which a symptom is reported. Especially for non-specific symptoms, including anosmia and dysgeusia, the prevalence is much higher in prospective studies.

Retrospective studies may help to capture associations but lead to underestimation of symptom prevalences, especially with symptoms like those in the current study. Thus, even under emergency conditions, it is necessary to bring out prospective studies at a much higher speed than has been achieved with the current pandemic.

Attention should also be paid to paring down unnecessary and potentially cumbersome regulations governing such studies, especially in pandemic situations and where the studies are not interventional in design. This would help to carry out research rapidly, where the results are available in a time frame that allows their application to ongoing policy decision-making.

Outpatient surveys are also required, and more attention should be paid to the more severe symptoms, unlike what was found in this review. “A rebalancing would be welcome with greater attention given to major neurological and neuropsychiatric disorders.”

High-quality studies were few, limiting the quality of the evidence. The long-term impact of COVID-19 on neuropsychiatric health is also an open question, which can be addressed only by prospective cohort studies.

If there is a real increase in the incidence of these complications, services and facilities need to be set up to anticipate the increase in neuropsychiatric cases, especially if they become chronic. Such care must begin in the acute phase, given that non-specific features are so common as to suggest that neurological and neuropsychiatric manifestations are the norm in COVID-19.

And finally, “Although long-term evidence from this earliest literature was sparse, it gives some initial indication that the symptoms described in ‘long COVID’ may be a continuation of some of those experienced in the acute phase of the illness.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Rogers, J. P. et al. (2021). The neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives. medRxiv preprint. doi: https://doi.org/10.1101/2021.02.24.21252335, https://www.medrxiv.org/content/10.1101 ... 21252335v1
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Re: Cognitive disorders associated with risk for developing severe COVID-19

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Negative impact of pandemic reduces people's cognitive capacity

3/8/21


https://www.news-medical.net/news/20210 ... acity.aspx


Lockdown and other restrictions imposed to control the COVID-19 pandemic have had unseen negative effects on the cognitive capacity and mental health of the population. A study led by the UOC's research group Open Evidence, in collaboration with international universities and BDI Schlseinger Group Market Research, has gauged the impact of the measures taken during the first and second waves of the virus on citizens of three European Union countries.

The study concludes that the shock produced by the situation has reduced people's cognitive capacity, leading them to take more risks, despite the risk of contagion, and make poorer choices, including a tendency to be less altruistic and the desire to punish others.

The study, published in the open access journal ScientificReports, published by Nature, analyses the relationship between the negative impact of pandemic control measures and people's cognitive functioning and risk, time and social preferences.

The sample consisted of nearly 5,000 volunteers from Spain, Italy and the United Kingdom- three countries criticized for their poor management of the pandemic, where lockdown has had a greater impact on their populations than in other European states. The participants were asked to respond to questionnaires during the first and second waves of the pandemic.

In the first of the two questionnaires, the researchers collected data on levels of exposure to four types of impacts during lockdown: occupational, health, mental health, and stress. In the second, they measured the cognitive function of the volunteers, as well as a series of parameters related to risk, decision-making, altruism, and reciprocity, among others.

" We wanted to explore the impact of lockdown and other COVID-19-related restrictions on people's lives and how this affected their decision-making."

- Francisco Lupiáñez, Professor of Information and Communication Sciences and Member of Open Evidence

The results of the study show that those who were more exposed to the consequences of the effects of lockdown also experienced more diminished cognitive capacity, made riskier decisions, and suffered reduced civic-mindedness.

"People's impaired decision-making abilities were impaired, and their reactions were not those we might have expected," said the researcher. "Instead of being more careful because they were in a pandemic, they were taking risks, because they couldn't take it any more."As for their relations with others, "they wanted, for example, those who did not wear masks or evaded restrictions to be punished, even though they themselves were more likely to make riskier choices".

According to Lupiáñez, "very difficult choices were made without taking into account the social cost involved. They only took into account a single, short-term perspective. And now we know that four out of ten people were at risk of suffering a mental health-related illnessas a result of the shock produced by this pandemic. All this will have implications in the medium term".

Another of the effects identified by the authors of this paper is that, under the shock of the pandemic, people tended to want immediate benefits and made on-the-spot decisions, some of them momentous, such as deciding to move from the city to a rural setting. "These were decisions in which the cost-benefit assessment was highly conditioned by the pandemic. It seemed as if the world was coming to an end and people preferred to benefit today, immediately, without thinking about tomorrow," said Lupiáñez.

According to the authors, their conclusions have important implications in terms of public health. The current pandemic and the various mitigation strategies, such as lockdowns, have had significant detrimental consequences in terms of occupational and health impacts. It is important, they say, that these be taken into account in "designing better responses and communication campaigns for future pandemics".

Source:

Universitat Oberta de Catalunya

Journal reference:

Bogliacino, F., et al. (2021) Negative shocks predict change in cognitive function and preferences: assessing the negative affect and stress hypothesis. Scientific Reports. doi.org/10.1038/s41598-021-83089-0.
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Re: Cognitive disorders associated with risk for developing severe COVID-19

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COVID-19 patients with dementia have higher risk for complications, mortality

3/31/21


https://www.news-medical.net/news/20210 ... ality.aspx


Early in the pandemic, neurologists expressed concern that COVID-19 patients with dementia may be at higher risk for complications and mortality.

But those fears have not been realized, according to a new study of patients who were hospitalized with COVID-19 during the first wave of the pandemic in New York City. The study, led by James Noble, MD, MS, associate professor of neurology at Columbia University Vagelos College of Physicians and Surgeons and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and Amro Harb, a Vagelos medical student, was published this month in the Journal of Alzheimer's Disease.

Though the study found a greater proportion of patients with dementia had died, "other factors, including age and comorbidities, were really the driving factors and not dementia itself," Noble says.

One unmistakable difference among patients, however, was the greater incidence of delirium in those with dementia.

"Early in the pandemic, we received many calls from caregivers about the sudden development of confusion and delirium in our dementia patients, even in those with only mild COVID symptoms," Noble says. "Delirium and confusion are common in elderly patients with other types of infections, including pneumonia, influenza, and urinary tract infections, and we realized delirium might be an unrecognized symptom of COVID-19 in this population."

That observation was reflected in the data from the hospitalized patients, where delirium was found in more than 36% of patients with dementia versus less than 12% of patients without dementia.

The dementia patients with COVID-19 were also less likely to report subjective symptoms such as shortness of breath, muscle aches, chills, nausea, or headaches compared with patients without dementia.

"It's hard to say if all of these are true differences," Noble says. "We know that, in general, people with dementia may be less likely to report some of the symptoms that we have come to recognize as typical COVID-19 symptoms because of poor awareness or they just don't remember to report these things."

Regardless of the reason behind the differences, Noble says the study suggests we may need to look beyond conventional symptoms associated with COVID-19 in this population and consider confusion and delirium as possible common signs of infection.

" The CDC has recognized new confusion is a 'warning sign' of COVID-19, and this study suggests this symptom was especially common in people with dementia hospitalized with COVID-19. This is important for caregivers and health care providers of homebound Alzheimer's patients who have not been vaccinated yet."

- James Noble, MD, MS, Associate Professor of Neurology, Columbia University Vagelos College of Physicians and Surgeons

Source:

Columbia University Irving Medical Center

Journal reference:

Harb. A., et al. (2021) Clinical Features and Outcomes of Patients with Dementia Compared to an Aging Cohort Hospitalized During the Initial New York City COVID-19 Wave. Journal of Alzheimer's Disease. doi.org/10.3233/JAD-210050.
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