Candace M Marsters, Jeffrey A Bakal, Grace Y Lam, Finlay A McAlister, Christopher Power, Brain, awae117, https://doi.org/10.1093/brain/awae117, 20 April 2024
Abstract
Determining the frequency and outcomes of neurological disorders associated with coronavirus disease 2019 (COVID-19) is imperative for understanding risks and for recognition of emerging neurological disorders. We investigated the susceptibility and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among persons with premorbid neurological disorders, in addition to the post-infection incidence of neurological sequelae, in a case–control population-based cohort.
Using health service data collected between 1 March 2020 and 30 June 2021, we constructed a cohort of SARS-CoV-2 RNA-positive (n = 177 892) and -negative (n = 177 800) adults who were age, sex and comorbidity matched and underwent RT-PCR testing at similar times. COVID-19-associated mortality rates were examined within the cohort. Neurological sequelae were analysed during the acute (<3 months) and the post-acute (3–9 months) phases post-infection.
The risk of death was significantly greater in the SARS-CoV-2 RNA-positive (2140 per 100 000 person years) compared with RNA-negative (922 per 100 000 person years) over a follow-up of 9 months, particularly amongst those with premorbid neurological disorders: adjusted odds ratios (95% confidence interval) in persons with a prior history of parkinsonism, 1.65 (1.15–2.37); dementia, 1.30 (1.11–1.52); seizures, 1.91 (1.26–2.87); encephalopathy, 1.82 (1.02–3.23); and stroke, 1.74 (1.05–2.86). There was also a significantly increased risk for diagnosis of new neurological sequelae during the acute time phase after COVID-19, including encephalopathy, 2.0 (1.10–3.64); dementia, 1.36 (1.07–1.73); seizure, 1.77 (1.22–2.56); and brain fog, 1.96 (1.20–3.20). These risks persisted into the post-acute phase after COVID-19, during which inflammatory myopathy (2.57, 1.07–6.15) and coma (1.87, 1.22–2.87) also became significantly increased.
Thus, persons with SARS-CoV-2 infection and premorbid neurological disorders are at greater risk of death, and SARS-CoV-2 infection was complicated by increased risk of new-onset neurological disorders in both the acute and post-acute phases of COVID-19.