A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the disease, including stroke and an altered mental state such as brain inflammation, psychosis and dementia-like symptoms.
The findings are published today in The Lancet Psychiatry and provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform the next steps in neuroscience COVID-19 research and health policy planning.
Increasingly, concerns regarding potential neurological complications of COVID-19 are being reported. However, most published reports have been limited to individual cases or small case series and even larger studies have been limited by both geography and specialty. Consequently, many important questions remain, such as how common complications are, whether novel syndromes are emerging, and which people are most at risk.
To address this, the CoroNerve Studies Group, a collaboration between the universities of Liverpool, Southampton, Newcastle and UCL, developed a rapid notification case identification system across the spectrum of major UK Neuroscience Professional Bodies, representing neurology, stroke, psychiatry, and intensive care.
During three weeks of the exponential pandemic phase, the researchers identified 153 cases from across the UK who had both a new COVID-19 diagnosis and a new neurological or psychiatric diagnosis requiring hospital admission, including those admitted to intensive care and/or recovering from critical illness.
The median age of the patients was 71 (23-94) years. Of the 125 patients for whom complete clinical data was available, 57 (44%) suffered ischemic strokes and 39 (31%) experienced an altered mental state reflecting both neurological and psychiatric diagnoses.
Whereas 61 (82%) cases of cerebrovascular events occurred in those over 60 years old, half of cases with an altered mental state were under 60 years old.
Dr Benedict Michael, who led the study for the University of Liverpool said: “Whilst an altered mental state was being reported by some clinicians, we were surprised to identify quite so many cases, particularly in younger patients, and by the breadth of clinical syndromes ranging from brain inflammation (encephalitis) through to psychosis and catatonia.
“Clinicians should be alert to the possibility of patients with COVID-19 developing these complications and, conversely, of the possibility of COVID-19 in patients presenting with acute neurological and psychiatric syndromes.”
It is not possible to draw conclusions about the total proportion of COVID-19 patients likely to be affected based on this study. Larger studies are now needed to identify the broader cohort of COVID-19 patients both in and outside of hospitals, to determine clearer estimates of the prevalence of these complications, those at risk, and impact on recovery.
Co-author Professor Tom Solomon, Director of the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool said: “This study provides a great snapshot of the spectrum of COVID-19 associated neurological disease in the UK. Now we can recognise these problems, we need to understand in more detail why some patients are developing these complications, and what we can do to stop it. It will also be interesting to see how these data compare with other countries.”
The CoroNerve Studies Group is supported by the Association of British Neurologists, Royal College of Psychiatrists, British Association of Stroke Physicians, British Paediatric Neurology Association, NeuroAnaesthesia and Critical Care Society, Intensive Care Society, Faculty of Intensive Care Medicine and the Encephalitis Society.
The researchers are supported by grants from the Medical Research Council, Wellcome, National Institute of Health Research and Academy of Medical Sciences.
Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study, The Lancet Psychiatry, https://doi.org/10.1016/S2215-0366(20)30287-X