Neurologic Manifestations of Long COVID Disproportionately Affect Young and Middle-Age Adults

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-11-22 DOI:10.1002/ana.27128

Natasha A. Choudhury MD, Shreya Mukherjee BA, Tracey Singer BS, Aditi Venkatesh BS, Gina S. Perez Giraldo MD, Millenia Jimenez BS, Janet Miller BS, Melissa Lopez MPH, Barbara A. Hanson PhD, Aasheeta P. Bawa PA-C, Ayush Batra MD, Eric M. Liotta MD, Igor J. Koralnik MD

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Abstract

Objective

To investigate neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients across the adult lifespan.

Methods

Cross-sectional study of the first consecutive 200 PNP and 1,100 NNP patients evaluated at a Neuro-coronavirus disease 2019 (COVID-19) clinic between May 2020 and March 2023. Patients were divided into younger (18–44 years), middle-age (45–64 years), and older (65+ years) age groups.

Results

Younger and middle-age individuals accounted for 142 of 200 (71%) of PNP and 995 of 1100 (90.5%) of NNP patients. Significant age-related differences in the frequencies of comorbidities and abnormal neurologic findings demonstrated higher prevalence in older patients. Conversely, 10 months from COVID-19 onset, we found significant age-related differences in Neuro-PASC symptoms indicating lower prevalence, and therefore, symptom burden, in older individuals. Moreover, there were significant age-related differences in subjective impression of fatigue (median [interquartile range (IQR)] patient-reported outcomes measurement information system [PROMIS] score: younger 64 [57–69], middle-age 63 [57–68], older 60.5 [50.8–68.3]; p = 0.04) and sleep disturbance (median [IQR] PROMIS score: younger 57 [51–63], middle-age 56 [53–63], older 54 [46.8–58]; p = 0.002) in the NNP group, commensurate with higher impairment in quality of life (QoL) among younger patients. Finally, there were significant age-related differences in objective executive function (median [IQR] National Institutes of Health [NIH] toolbox score: younger 48 [35–63], middle-age 49 [38–63], older 54.5 [45–66.3]; p = 0.01), and working memory (median [IQR] NIH toolbox score: younger 47 [40–53], middle-age 50 [44–57], older 48 [43–58]; p = 0.0002) in NNP patients, with the worst performance coming from the younger group.

Interpretation

Younger and middle-age individuals are disproportionally affected by Neuro-PASC regardless of acute COVID-19 severity. Although older people more frequently have abnormal neurologic findings and comorbidities, younger and middle-age patients suffer from a higher burden of Neuro-PASC symptoms and cognitive dysfunction contributing to decreased QoL. Neuro-PASC principally affects adults in their prime, contributing to profound public health and socioeconomic impacts warranting dedicated resources for prevention, diagnosis and interventions. ANN NEUROL 2025;97:369–383

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长COVID的神经系统表现对中青年成人的影响不成比例。

目的研究SARS-CoV-2感染急性后遗症（Neuro-PASC）住院后Neuro-PASC（PNP）和非住院Neuro-PASC（NNP）患者在整个成年期的神经系统表现：对2020年5月至2023年3月期间在2019年神经-冠状病毒疾病（COVID-19）诊所接受评估的首批连续200名PNP和1100名NNP患者进行横断面研究。患者被分为年轻组（18-44 岁）、中年组（45-64 岁）和老年组（65 岁以上）：200 名 PNP 患者中有 142 名（71%）为中青年，1100 名 NNP 患者中有 995 名（90.5%）为中老年。在合并症和神经系统异常发现的频率方面，年龄差异显著，这表明老年患者的发病率更高。相反，在 COVID-19 发病 10 个月后，我们发现神经-PASC 症状存在显著的年龄相关性差异，这表明老年患者的患病率较低，因此症状负担也较轻。此外，疲劳的主观印象也存在明显的年龄相关性差异（患者报告结果测量信息系统[PROMIS]评分的中位数[四分位数间距（IQR）]：年轻人 64 [57-69]，中年人 63 [57-68]，老年人 60.5[50.8-68.3]；p = 0.04）和睡眠障碍（PROMIS 评分中位数[IQR]：年轻人 57[51-63]，中年人 56[53-63]，老年人 54[46.8-58]；p = 0.002），年轻患者的生活质量（QoL）受损程度更高。最后，客观执行功能（美国国立卫生研究院工具箱评分的中位数 [IQR]：年轻 48 [35-63]，中年 49 [38-63]，老年 54.5 [45-66.3]；p = 0.01）和工作记忆（中位数 [IQR]：年轻 48 [35-63]，中年 49 [38-63]，老年 54.5 [45-66.3]；p = 0.002）存在明显的年龄相关差异。01）和工作记忆（NIH 工具箱评分中位数 [IQR]：年轻组 47 [40-53]，中年组 50 [44-57]，老年组 48 [43-58]；p = 0.0002），年轻组表现最差：无论急性 COVID-19 的严重程度如何，中青年人受神经-PASC 的影响都不成比例。虽然老年人更常出现神经系统异常和合并症，但中青年患者的神经-PASC 症状和认知功能障碍负担更重，导致生活质量下降。神经-PASC 主要影响正值壮年的成年人，对公共卫生和社会经济产生深远影响，因此需要投入专门资源进行预防、诊断和干预。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.