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Ganesh A, Rosentreter RE, Chen Y, Mehta R, McLeod GA, Wan MW, Krett JD, Mahjoub Y, Lee AS, Schwartz IS, Richer LP, Metz LM, Smith EE, Hill MD. Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study. CMAJ Open 2023; 11:E696-E705. [PMID: 37553227 PMCID: PMC10414975 DOI: 10.9778/cmajo.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Various neurologic manifestations have been reported in patients with COVID-19, mostly in retrospective studies of patients admitted to hospital, but there are few data on patients with mild COVID-19. We examined the frequency and persistence of neurologic/neuropsychiatric symptoms in patients with mild COVID-19 in a 1-year prospective cohort study, as well as assessment of use of health care services and patient-reported outcomes. METHODS Participants in the Alberta HOPE COVID-19 trial (hydroxychloroquine v. placebo for 5 d), managed as outpatients, were prospectively assessed 3 months and 1 year after their positive test result. They completed detailed neurologic/neuropsychiatric symptom questionnaires, the telephone version of the Montreal Cognitive Assessment (T-MoCA), the Kessler Psychological Distress Scale (K10) and the EuroQol EQ-5D-3L (measure of quality of life). Close informants completed the Mild Behavioural Impairment Checklist (MBI-C) and the Informant Questionnaire on Cognitive Decline in the Elderly. We also tracked use of health care services and neurologic investigations. RESULTS The cohort consisted of 198 participants (87 female [43.9%] median age 45 yr, interquartile range 37-54 yr). Of the 179 participants with symptom assessments, 139 (77.6%) reported at least 1 neurologic symptom, the most common being anosmia/dysgeusia (99 [55.3%]), myalgia (76 [42.5%]) and headache (75 [41.9%]). Forty patients (22.3%) reported persistent symptoms at 1 year, including confusion (20 [50.0%]), headache (21 [52.5%]), insomnia (16 [40.0%]) and depression (14 [35.0%]); 27/179 (15.1%) reported no improvement. Body mass index (BMI), a history of asthma and lack of full-time employment were associated with the presence and persistence of neurologic/neuropsychiatric symptoms; female sex was independently associated with both (presence: odds ratio [OR] adjusted for age, race, BMI, history of asthma and neuropsychiatric history 5.04, 95% confidence interval [CI] 1.58 to 16.10). Compared to participants without persistent symptoms, those with persistent symptoms had more hospital admissions and family physician visits, and worse MBI-C scores and less frequent independence for instrumental activities at 1 year (83.8% v. 97.8%, p = 0.005). Patients with any or persistent neurologic symptoms had worse psychologic distress (K10 score ≥ 20: adjusted OR 12.1, 95% CI 1.4 to 97.2) and quality of life (median EQ-5D-3L visual analogue scale rating 75 v. 90, p < 0.001); 42/84 (50.0%) had a T-MoCA score less than 18 at 3 months, as did 36 (42.9%) at 1 year. Participants who reported memory loss were more likely than those who did not report such symptoms to have informant-reported cognitive-behavioural decline (1-yr MBI-C score ≥ 6.5: adjusted OR 15.0, 95% CI 2.42 to 92.60). INTERPRETATION Neurologic/neuropsychiatric symptoms were commonly reported in survivors of mild COVID-19, and they persisted in 1 in 5 patients 1 year later. Symptoms were associated with worse participant- and informant-reported outcomes. Trial registration: ClinicalTrials.gov, no. NCT04329611.
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Affiliation(s)
- Aravind Ganesh
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta.
| | - Ryan E Rosentreter
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yushi Chen
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Rahul Mehta
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Graham A McLeod
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Miranda W Wan
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Jonathan D Krett
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yasamin Mahjoub
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Angela S Lee
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Ilan S Schwartz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Lawrence P Richer
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Luanne M Metz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Eric E Smith
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Michael D Hill
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
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