Neurodegenerative Disease and COVID-19: Assessing Outcomes in Hospitalized Patients

TORRANCE, CALIFORNIA – JANUARY 21: (EDITORIAL USE ONLY) U.S. Air Force 1st Lt. Allyson Black, a registered nurse, cares for COVID-19 patients in a makeshift ICU (Intensive Care Unit) at Harbor-UCLA Medical Center on January 21, 2021 in Torrance, California. The hospital is utilizing about 20 military medical personnel deployed by the Department of Defense to help shore up overwhelmed staff at a number of medical centers in Southern California. The hospital is over its ICU capacity due to the coronavirus and has been forced to treat multiple COVID-19 patients who require ICU level care together in rooms which were designed for lower levels of care. California has become the first state in the nation to record 3 million known COVID-19 infections. Los Angeles County reported more than 250 COVID-19 fatalities on January 21. (Photo by Mario Tama/Getty Images)
A team of researchers assessed COVID-19 outcomes in patients with neurodegenerative diseases compared with patients without such disease.

Short-term mortality and intensive care unit (ICU) admission rates among patients with neurodegenerative disorders who are hospitalized with COVID-19 may not differ from age-matched hospitalized patients with COVID-19 who do not have neurological disorders, according to findings published in Neurology Clinical Practice. Study results also suggested that patients with neurodegenerative disorders who are hospitalized for COVID-19 develop encephalopathy at higher rates than patients without neurodegenerative disorders and are more likely to be discharged to nursing home or hospice.

Although factors such as age, obesity, hypertension, cardiovascular disease, and diabetes are have established as severe risk factors for worse outcomes of COVID-19 infection, the effects of neurodegenerative disease on COVID-19 are not well understood.

To bridge this knowledge gap, a team of investigators conducted a retrospective cohort study at 3 hospitals in the Chicagoland area of Illinois to assess short-term morbidity and mortality in patients with pre-existing neurodegenerative disorders who were hospitalized for COVID-19. They then compared these outcomes with those of age-matched patients (controls).

A total of 264 patients were included in the study; 132 patients were in the neurodegenerative disorder group and 132 patients were in the control group. Baseline characteristics such as age, sex, BMI, race, and medical comorbidities were similar between both patient groups.

More patients in the control group were Hispanic or Latin American (P <.012). The most common baseline neurodegenerative disorders were unspecified dementia, Parkinson disease or Parkinsonism, Alzheimer disease, vascular dementia, multiple sclerosis, ataxia, and frontotemporal dementia. Some patents had multiple diagnoses. Patients with neurodegenerative disorders more often resided in nursing home prior to hospitalization compared with patients in the control group (P <.0001).

Although mortality was similar between the 2 patient groups (P =.45), intubation or mechanical ventilation was more common among patients in the control group (P =.0075). Study researchers observed no difference in ventilation or intubation between the 2 groups after adjusting for code status. The relative risk (RR) for intubation and ventilation among patients with neurodegenerative disorders was 0.88 without controlling for do not resuscitate (DNR) or intubate (DNI) and 1.04 after controlling for DNR/DNI.

Symptoms of COVID-19 including fever or chills, weakness or fatigue, loss of appetite, nausea or vomiting, and sore throat were similar between the 2 patient groups. Patients in the control cohort more often experienced cough, shortness of breath, muscle pain or myalgias, diarrhea or abdominal pain, headache, and loss of smell of taste, while patients with neurodegenerative disorders more often experienced altered mental status or confusion.

Patients in the control cohort had a higher rate of supplementary oxygen use compared with the neurodegenerative cohort (95.1% vs 83.2%, respectively; P =.0012). Contrastingly, patients in the neurodegenerative disorders group experienced encephalopathy more frequently than patients in the control group (62.4% vs 20.4%, respectively; P <.0001).

Based on baseline characteristics, risk factors for 90-day mortality after admission for patients with neurodegenerative disorders included being White (odds ratio [OR], 3.3; P =.0081) and presenting with COVID-19 symptom of confused or altered mental status (OR, 3.61; P =.016).

Conversely, for patients in the control group, presenting with asthma or chronic lung disease comorbidity was associated with an increased risk for mortality (OR, 2.59; P =.29); however, presenting with COVID-19 symptoms of muscle pain or myalgias (OR, 0.38; P =.040) and weakness or fatigue (OR, 0.32; P =.0074) were linked with a reduced risk for mortality.

“In particular, health care providers should be aware that neurodegenerative patients may be more likely to have ‘atypical’ presentation of COVID-19 infection with mental status changes, as opposed to respiratory symptoms,” the study researchers noted. “Future studies should investigate long-term outcomes of neurodegenerative patients who survive COVID-19 infection and targeted intervention strategies to protect this vulnerable population,” they concluded.

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

Reference

Patel RA, Stebbins GT, Kishen EB, Barton B. COVID-19 outcomes in hospitalized patients with neurodegenerative disease: a retrospective cohort study. Neurol Clin Pract. Published online July 16, 2021. doi:10.1212/cpj.0000000000001117