Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study

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Ross Russell, AL, Hardwick, M ORCID: 0000-0002-4639-4522, Jeyanantham, A, White, LM, Deb, S, Burnside, G ORCID: 0000-0001-7398-1346, Joy, HM, Smith, CJ, Pollak, TA, Nicholson, TR et al (show 30 more authors) , Davies, NWS, Manji, H, Easton, A, Ray, S, Zandi, MS ORCID: 0000-0002-9612-9401, Coles, JP ORCID: 0000-0003-4013-679X, Menon, DK, Varatharaj, A, Mccausland, B, Ellul, MA ORCID: 0000-0002-6115-8245, Thomas, N, Breen, G, Keddie, S ORCID: 0000-0002-2102-6053, Lunn, MP ORCID: 0000-0003-3174-6027, Burn, JPS, Quattrocchi, G, Dixon, L, Rice, CM, Pengas, G, Al-Shahi Salman, R, Carson, A, Joyce, EM, Turner, MR ORCID: 0000-0003-0267-3180, Benjamin, LA ORCID: 0000-0002-9685-1664, Solomon, T ORCID: 0000-0001-7266-6547, Kneen, R, Pett, S, Thomas, RH, Michael, BD ORCID: 0000-0002-8693-8926 and Galea, I ORCID: 0000-0002-1268-5102 (2021) Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study Brain Communications, 3 (3). fcab168-. ISSN 2632-1297, 2632-1297

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Abstract

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 priori clinical 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 <60 years. Relative to those >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.

Item Type:	Article
Uncontrolled Keywords:	COVID-19, SARS-CoV-2, encephalopathy, stroke, neurology
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	01 Feb 2022 15:53
Last Modified:	24 Jan 2026 03:11
DOI:	10.1093/braincomms/fcab168
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3147967
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