Summary: Six months after COVID-19 infection, two-thirds of study participants continued to experience neurological symptoms—most commonly memory problems, difficulty concentrating, headaches, and fatigue—that affected daily life and quality of life.
Source: UC San Diego School of Medicine
Researchers at the University of California San Diego School of Medicine are conducting a longitudinal study to track neurological symptoms in people with post-acute sequelae of SARS-CoV-2 infection, commonly called long COVID.
The first set of findings, published June 15, 2022 in Annals of Clinical and Translational Neurology, describes the presence and evolution of neurological complaints among participants who experienced mild-to-moderate acute COVID-19. While many individuals improved over time, a majority continued to report some degree of neurologic symptoms six months after their initial infection.
Between October 2020 and October 2021, the team enrolled 56 people who reported new neurological symptoms following COVID-19. Participants completed a standard neurologic examination, cognitive testing using the Montreal Cognitive Assessment (MoCA), self-reported symptom surveys, and an optional brain scan. Baseline evaluations occurred a few months after acute infection and were repeated at three- and six-month follow-ups.
At the initial visit, fatigue was the most commonly reported symptom (89% of participants), followed by headaches (80%). Other frequent complaints included memory impairment, insomnia, and reduced ability to concentrate. Eighty percent said these problems had a measurable impact on their quality of life.
By the six-month visit, only about one-third of participants reported full resolution of neurologic symptoms. The remaining two-thirds still experienced at least one persistent symptom, although most reported that symptom severity had lessened. Memory problems and decreased concentration were the most common ongoing issues at six months.
Importantly, the researchers emphasize that those with persistent symptoms generally had no prior neurologic diagnoses before their SARS‑CoV‑2 infection, indicating these complaints emerged after COVID-19.
“It’s encouraging that many people showed improvement by six months, but not everyone recovered fully,” said senior author Jennifer S. Graves, MD, PhD, associate professor at UC San Diego School of Medicine and neurologist at UC San Diego Health. “Some participants are professionals who would be expected to perform above average on cognitive tests, yet months after COVID-19 they continue to score below normal.”
The study also identified a novel clinical pattern in a subset of participants. About 7% of individuals developed a combination of tremor, unsteady gait (ataxia), and cognitive dysfunction. The investigators named this cluster Post-Acute Sequelae of COVID-19 with Tremor, Ataxia and Cognitive deficit (PASC-TAC).
“These are people who had no prior neurologic problems and now show physical incoordination alongside cognitive difficulties,” Graves said. “We did not expect to see this pattern and want clinicians to be aware so they can recognize similar cases.”
The mechanisms behind these delayed neurologic effects remain under investigation. While direct viral invasion of the brain is still being studied, Graves and colleagues suggest a more likely explanation is that SARS‑CoV‑2 triggers an inflammatory or autoimmune response that affects nervous system function over time.
The research team will continue to follow participants annually for up to ten years to better understand long-term outcomes. Future work will also examine whether different viral variants or vaccination status influence the course and persistence of neurologic symptoms.
“That cognition and quality of life remain affected long after acute infection is an issue that requires attention from clinicians, researchers, and public health planners,” Graves added. “We need to determine how common these problems are, identify the biological causes, and plan ongoing care for those affected. This study represents an important early step in that process.”
Co-authors include Jacqueline E. Shanley, Andrew F. Valenciano, Garrett Timmons, Annalise E. Miner, Visesha Kakarla, Jennifer H. Yang, Amanda Gooding, Marc A. Norman, Sarah J. Banks, the NeuCovid Team, Michelle L. Ritter, Ronald J. Ellis, and Lucy Horton at UC San Diego, and Torge Rempe at the University of Florida.
About this long-COVID and neurology research news
Author: Nicole Mlynaryk
Source: UCSD School of Medicine
Contact: Nicole Mlynaryk – UCSD
Image: The image is in the public domain
Original Research: Open access. “Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms” by Jennifer S. Graves et al., Annals of Clinical and Translational Neurology (published June 15, 2022).
Abstract
Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms
Objective
To characterize initial features and subsequent evolution of neurologic post-acute sequelae of SARS‑CoV‑2 infection (neuro‑PASC) in patients both with and without prior neurologic disease.
Methods
Participants reporting neurologic symptoms after acute SARS‑CoV‑2 infection were enrolled between October 9, 2020 and October 11, 2021. Clinical assessments included a history of SARS‑CoV‑2 infection, neurologic review of systems, neurologic exam, the Montreal Cognitive Assessment (MoCA), and self-reported symptom surveys at baseline and at six-month follow-up.
Results
Fifty-six participants (69% female, mean age 50 years; 29% had prior neurologic conditions such as multiple sclerosis) were enrolled; 27 had completed the six-month visit at the time of reporting. Acute infection severity was most often described as mild (39.3%) or moderate (42.9%). At baseline, the most frequent neurologic complaints were fatigue (89.3%) and headaches (80.4%). At six months, memory impairment (68.8%) and decreased concentration (61.5%) were most common, though average symptom severity declined overall. One-third of participants reported complete symptom resolution by six months. MoCA scores improved on average from baseline to six months, although 26.3% of participants showed decreased scores. A syndrome of tremor, ataxia, and cognitive dysfunction (PASC‑TAC) was observed in 7.1% of patients.
Interpretation
Early in the neuro‑PASC course, fatigue and headache are the predominant complaints. By six months, cognitive issues—especially memory impairment and poor concentration—are most prominent. Although many symptoms trend toward improvement, only about one-third of participants reported complete recovery at six months, underscoring the need for ongoing study and clinical attention to long-term neurologic effects of COVID-19.