The neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives

  1. Jonathan P Rogers
  2. Cameron Watson
  3. James Badenoch
  4. Benjamin Cross
  5. Matthew Butler
  6. Jia Song
  7. Danish Hafeez
  8. Hamilton Morrin
  9. Emma Rachel Rengasamy
  10. Lucretia Thomas
  11. Silviya Ralovska
  12. Abigail Smakowski
  13. Ritika Dilip Sundaram
  14. Camille Kaitlyn Hunt
  15. Mao Fong Lim
  16. Daruj Aniwattanapong
  17. Vanshika Singh
  18. Zain Hussain
  19. Stuti Chakraborty
  20. Ella Burchill
  21. Katrin Jansen
  22. Heinz Holling
  23. Dean Walton
  24. Thomas A Pollak
  25. Mark Ellul
  26. Ivan Koychev
  27. Tom Solomon
  28. Benedict Daniel Michael
  29. Timothy R Nicholson
  30. Alasdair G Rooney
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Abstract

Objectives

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.

Methods

We searched MEDLINE, Embase, PsycInfo and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.

Results

13,292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% [35.2—51.3], n=15,975, 63 studies), weakness (40.0% [27.9—53.5], n=221, 3 studies), fatigue (37.8% [31.6—44.4], n=21,101, 67 studies), dysgeusia (37.2% [30.0—45.3], n=13,686, 52 studies), myalgia (25.1% [19.8—31.3], n=66.268, 76 studies), depression (23.0 % [11.8—40.2], n=43,128, 10 studies), headache (20.7% [95% CI 16.1—26.1], n=64,613, 84 studies), anxiety (15.9% [5.6—37.7], n=42,566, 9 studies) and altered mental status (8.2% [4.4—14.8], n=49,326, 19 studies). Heterogeneity for most clinical manifestations was high.

Conclusions

Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

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