Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study
Authors: Frontera Jennifer A. , Yang Dixon , Medicherla Chaitanya , Baskharoun Samuel , Bauman Kristie , Bell Lena , Bhagat Dhristie , Bondi Steven , Chervinsky Alexander , Dygert Levi , Fuchs Benjamin , Gratch Daniel , Hasanaj Lisena , Horng Jennifer , Huang Joshua , Jauregui Ruben , Ji Yuan , Kahn D. Ethan , Koch Ethan , Lin Jessica , Liu Susan B. , Olivera Anlys , Rosenthal Jonathan , Snyder Thomas , Stainman Rebecca S. , Talmasov Daniel , Thomas Betsy , Valdes Eduard , Zhou Ting , Zhu Yingrong , Lewis Ariane , Lord Aaron S. , Melmed Kara , Meropol Sharon B. , Thawani Sujata , Troxel Andrea B. , Yaghi Shadi , Balcer Laura J. , Wisniewski Thomas , Galetta Steven L. 
Published: February 2022

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.