Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study

  1. Jennifer A. Frontera
  2. Dixon Yang
  3. Chaitanya Medicherla
  4. Samuel Baskharoun
  5. Kristie Bauman
  6. Lena Bell
  7. Dhristie Bhagat
  8. Steven Bondi
  9. Alexander Chervinsky
  10. Levi Dygert
  11. Benjamin Fuchs
  12. Daniel Gratch
  13. Lisena Hasanaj
  14. Jennifer Horng
  15. Joshua Huang
  16. Ruben Jauregui
  17. Yuan Ji
  18. D. Ethan Kahn
  19. Ethan Koch
  20. Jessica Lin
  21. Susan B. Liu
  22. Anlys Olivera
  23. Jonathan Rosenthal
  24. Thomas Snyder
  25. Rebecca S. Stainman
  26. Daniel Talmasov
  27. Betsy Thomas
  28. Eduard Valdes
  29. Ting Zhou
  30. Yingrong Zhu
  31. Ariane Lewis
  32. Aaron S. Lord
  33. Kara Melmed
  34. Sharon B. Meropol
  35. Sujata Thawani
  36. Andrea B. Troxel
  37. Shadi Yaghi
  38. Laura J. Balcer
  39. Thomas Wisniewski
  40. Steven L. Galetta
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Abstract

Background/Objectives

Little is known about trajectories of recovery 12-months after hospitalization for severe COVID.

Methods

We conducted a prospective, longitudinal cohort study of patients with and without neurological complications during index hospitalization for COVID-19 from March 10, 2020-May 20, 2020. Phone follow-up batteries were performed at 6- and 12-months post-COVID symptom onset. The primary 12-month outcome was the modified Rankin Scale (mRS) comparing patients with or without neurological complications using multivariable ordinal analysis. Secondary outcomes included: activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA) and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Changes in outcome scores from 6 to 12-months were compared using non-parametric paired-samples sign test.

Results

Twelve-month follow-up was completed in N=242 patients (median age 65, 64% male, 34% intubated during hospitalization) and N=174 completed both 6- and 12-month follow-up. At 12-months 197/227 (87%) had ≥1 abnormal metric: mRS>0 (75%), Barthel<100 (64%), t-MoCA≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%) and poor sleep (10%). 12-month mRS scores did not differ significantly among those with (N=113) or without (N=129) neurological complications during hospitalization after adjusting for age, sex, race, pre-COVID mRS and intubation status (adjusted OR 1.4, 95% CI0.8-2.5), though those with neurological complications had higher fatigue scores (T-score 47 vs 44, P=0.037). Significant improvements in outcome trajectories from 6- to 12-months were observed in t-MoCA scores (56% improved, median difference 1 point, P=0.002), and Neuro-QoL anxiety scores (45% improved, P=0.003). Non-significant improvements occurred in fatigue, sleep and depression scores in 48%, 48% and 38% of patients, respectively. Barthel and mRS scores remained unchanged between 6 and 12-months in >50% of patients.

Discussion

At 12-months post-hospitalization for severe COVID, 87% of patients had ongoing abnormalities in functional, cognitive or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a prior history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurological complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6- to 12-months. These results may not be generalizable to those with mild/moderate COVID.

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