Neurological

COVID-19 Mortality Associated with Neurological Manifestations in Older Adults

According to a systematic review and meta-analysis published in Neurology, up to a third of COVID-19 patients experienced at least one neurological manifestation and around 2% a stroke.

Studies have shown that COVID-19 affects the central nervous system, peripheral nervous system, and musculoskeletal system in patients, and there is an increase in cases of neurological symptoms, the researchers said. They tried to determine the association of the manifestations with the severity and mortality of COVID-19.

They searched for observational studies published in 2020 in PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library, and ClinicalTrials.gov that reported at least 1 new neurological manifestation due to confirmed and probable cases of COVID-19. They assessed the risk of bias of the studies with the tool of the Joanna Briggs Institute (JBI) and controlled the false detection rate (FDR) with the Benjamini-Hochberg method.

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All in all 350 studies with 55 countries were included in the systematic review. Of the 145,721 COVID-19 cases identified, 129,786 hospitalizations were required. Most (84.6%) of the studies had a low risk of bias: 14% had a moderate risk and 1.4% a high risk.

The most common of 24 identified neurological symptoms were fatigue (32%), myalgia (20%), myalgia or fatigue (31%), headache (13%), dizziness (7%), headache and dizziness combined (12%). Impairment of smell (19%), impairment of taste (21%), impairment of smell or taste (18%), acute confusion / delirium (11%), impaired consciousness (7%), arousal (45%).

Thirty-three studies included 17 neurological diagnoses. The most common neurological diagnosis was stroke (pooled prevalence in 29 studies 2%). These included 1% ischemic stroke or transient ischemic attack, 0.31% hemorrhagic stroke, and 0.12% cerebral vein thrombosis. In 3 studies, 24% of the cases involved neuropsychiatric disorders. In 4 studies, 5% of the cases involved an injury to the skeletal muscles.

In 48 studies (2829 severe cases and 7493 non-severe cases), the researchers found that skeletal muscle injury / damage in 2 studies (OR 3.29), impaired consciousness (OR 5.68) in 4 studies, and fatigue (OR 1.27 ) in 33 studies have been linked to severe COVID-19. They found that patients with severe COVID-19 had fewer changes in smell (OR 0.44, 8 studies) and taste (OR 0.62, 5 studies) compared to patients with mild cases.

In COVID-19 patients aged 60 years or older (n = 3176 hospitalized patients), the most common symptom was acute confusion / delirium (34%, 5 studies), followed by fatigue (20%, 9 studies) and myalgia (11. ). %, 10 studies). Pediatric patients (3,051 hospitalized, 20 studies) had the most common symptoms of fatigue or myalgia (17%, 2 studies), odor or taste disorders (13%, 2 studies), and headache (10%, 13 studies).

In 13 studies that identified neurological symptoms in non-hospitalized cases, patients who were not hospitalized were more likely to have odor disorders (50%), taste disorders (44%), headache (31%), and myalgia (31%). on. Hospital patients were more likely to experience fatigue (31%) and myalgia or fatigue (30%).

In 21 studies examining mortality, 770 of 2982 patients who experienced at least 1 neurological symptom died (pooled prevalence 27%). In patients aged 60 years or older, the risk of death was higher in patients with neurological symptoms (OR 1.80, 13 studies).

Study limitations included few data from prospective studies, lack of uniformity in diagnostic criteria for neurological manifestations, large inclusion (89%) of hospitalized cases, and confusing biases.

The researchers concluded: “Of those over 60, more than a third suffered from acute confusion / delirium; the presence of neurological manifestations in this group was associated with an almost doubling in mortality. The results must be interpreted taking into account the limitations of observational studies and the associated bias. “

Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device manufacturers. For a full list of author disclosures, see the original reference.

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Misra S, Kolappa K, Prasad M, et al. Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis. Neurol. Published online October 11, 2021. doi: 10.1212 / WNL.0000000000012930

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