Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present with acute neurological and psychiatric complications, notably altered mental states including new onset psychosis, dementia-like symptoms, and affective disorders, according to a nationwide, cross-specialty surveillance study published in Lancet Psychiatry. These findings may help direct research and policy efforts during the coronavirus disease 2019 (COVID-19) pandemic.

An online network of secure rapid-response case report notification portals, including the Association of British Neurologists, the British Association of Stroke Physicians, and the Royal College of Psychiatrists was developed during the global viral pandemic. Symptoms were categorized as cerebrovascular events (acute ischemic, hemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), peripheral neurology (nerve roots, peripheral nerves, neuromuscular junction, or muscle), altered mental status (acute alteration in personality, behavior, cognition, or consciousness), or other symptoms. Data were collected in the United Kingdom between April 3 and April 26, 2020.

A total of 153 patients had acute neurological and psychiatric complications. Complete clinical data was only available for 82% of the patients. A majority of these patients (92%) had laboratory confirmed SARS-CoV-2, 4% met the criteria for a probable infection, and 4% met the criteria for a possible viral infection. The median age was 71 years (range, 23-94 years), which was consistent with coronavirus infected averages in the United Kingdom.

Of the 125 patients with full clinical records, 77 (62%) had a cerebrovascular event, 57 had an ischemic stroke, 9 had intracerebral hemorrhage, and 1 had central nervous system vasculitis. A third of patients (n=39) presented with an altered mental state, including 9 patients with unspecified encephalopathy, 7 with encephalitis, and 23 fulfilling the clinical definition for psychiatric diagnoses.


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For the 23 patients meeting the requirement for a psychiatric diagnosis, 10 had new onset psychosis, 6 had a dementia-like neurocognitive syndrome, and 4 had an affective disorder. Of these patients, only 9% of the observed symptoms were exacerbations of existing conditions. Nearly half (49%) of the patients with altered mental state and 18% of the patients with a cerebrovascular event were under 60 years of age.

A potential limitation of this study was the amalgamation of data types, as the included information was both retrospectively and prospectively collected. Furthermore, symptoms were reported by a range of clinicians with differing specialties (stroke physicians, neurologists, psychiatrists, neuropsychiatrists, acute medicine physicians, and general practitioners), which may have introduced some bias.

The researchers observed that a disproportionate number of neuropsychiatric symptoms were more common for younger patients and cerebrovascular complications were seen among older patients. They concluded, “Our nationwide, clinician­reported cohort approach provides valuable and timely information that is urgently needed by clinicians, researchers, and funders to inform the immediate next steps in COVID­19 neuroscience-related research and health policy planning.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Varatharaj A, Thomas N, Ellul M A, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study [Published online June 25, 2020]. Lancet Psych. doi:10.1016/S2215-0366(20)30287-X.