Neurologic and psychiatric complaints are common in the 6 months following the diagnosis of COVID-19, with the highest risk among patients who had severe COVID-19, according to study results published in The Lancet Psychiatry.
Previous studies have raised concerns regarding neurologic and psychiatric complications of COVID-19. The objective of the current study was to provide large scale, robust, and long-term data on the potential neurologic and psychiatric sequelae of COVID-19.
Using data from the TriNetX electronic health records network, study researchers identified patients older than 10 years of age diagnosed with COVID-19, and each patient was matched to 2 control group participants. One matched control cohort included patients diagnosed with influenza, and another cohort included patients diagnosed with any respiratory tract infection in the same period.
The study included 236,379 patients diagnosed with COVID-19, including 190,077 patients who were not hospitalized, 46,302 patients who were hospitalized, 8945 patients admitted to an intensive therapy unit, and 6229 patients who received a diagnosis of encephalopathy.
Approximately a third (33.62%) of all patients diagnosed with COVID-19 had a neurologic or psychiatric diagnosis in the 6 months following the viral infection, with 12.84% receiving their first such diagnosis. The incidence was higher for patients admitted to an intensive therapy unit (46.42%).
The most common neurologic and psychiatric diagnoses in the whole COVID-19 cohort were mood, anxiety, or psychotic disorders (23.98%); substance use disorder (6.58%); and insomnia (5.42%); followed by nerve, nerve root, or plexus disorders (2.85%); ischemic stroke (2.10%); dementia (0.67%); intracranial hemorrhage (0.56%); parkinsonism (0.11%); encephalitis (0.10%); and Guillain-Barré syndrome (0.08%).
Compared with control group participants diagnosed with influenza, the risk for any neurologic or psychiatric complication was 44% greater in those who had COVID-19 (hazard ratio [HR], 1.44; 95% CI, 1.40-1.47) and the risk was 78% greater for any first diagnosis (HR, 1.78; 95% CI, 1.68-1.89). Patients with COVID-19 also had an increased risk for these complications compared with control group participants who had other respiratory tract infections (HR, 1.16; 95% CI, 1.14-1.17, for any diagnosis; HR, 1.32; 95% CI, 1.27-1.36, for any first diagnosis).
The severity of COVID-19 had a significant impact on the risk for these neurologic and psychiatric complications because the incidence and hazard ratios were greater in those who were hospitalized, and markedly elevated in those who were admitted to an intensive therapy unit or had developed encephalopathy.
The study had several limitations, including those associated with an electronic health records study, incomplete data on socioeconomic and lifestyle factors, under-recording of encephalopathy, and inability to rule out undiagnosed COVID-19 in the comparison cohorts.
“[T]he present data show that COVID-19 is followed by significant rates of neurological and psychiatric diagnoses over the subsequent 6 months. Services need to be configured, and resourced, to deal with this anticipated need,” concluded the study researchers.
Disclosure: One author is an employee of TriNetX. Please see the original reference for a full list of authors’ disclosures.
Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021;8(5):416-427. doi:10.1016/S2215-0366(21)00084-5