Neuropsychiatric consequences and radiological manifestations of COVID-19
Authors: Trofimova T. N. , Bogdan A. A. , Vinogradova E. I. , Rassokhin V. V. , Boeva E. V.  , Knizhnikova A. A. , Kushnir Ya. B. , Norka A. O. , Yurkovsky A. M. , Belyakov N. A. 
Published: February 2025

INTRODUCTION: In people who have experienced a new coronavirus infection (COVID-19), long COVID disorders can manifest as persistent cognitive and neuropsychiatric disorders that endanger daily activities and psychosocial adaptation. The long-term persistence and polymorphism of symptoms after COVID-19 is a growing concern. It is characterized by undulation, when some of the symptoms may temporarily disappear and then return again. As of 2024, the prevalence of long COVID is 6–7% in adults and about 1% in children. Using neuroimaging techniques is an integral part of the timely diagnosis of acute disorders and consequences associated with COVID-19.

OBJECTIVE: To assess the nature of health complaints, features of neurological and cognitive disorders and compare them with radiological changes in the brain in people in the post-COVID period.

MATERIALS AND METHODS: For the period from 2023–2024, 170 patients aged 18 to 60 years participated in the study, with a history of established fact of COVID-19, confirmed by polymerase chain reaction (PCR) SARS-CoV-2. The main socio-demographic and clinical and laboratory indicators were evaluated for all participants, with further radiological examination. As part of the neuropsychological examination, the Montreal Cognitive Assessment Scale (MoCA), «10 words» by A.R. was evaluated. Luria, «Schulte Tables», neuropsychological tests to study the state of praxis and the state of various aspects of gnosis, as well as a subjective assessment of 38 symptoms, which included: memory impairment, concentration, fatigue, anxiety, the presence of panic attacks, pain of various localizations, etc. The neuroimaging examination included structural MRI and  1 H-MRI, performed on a SIGNA Architect 3 Tl tomograph (GE HealthCare, General Electric, USA).

RESULTS: The majority of the (n=170) was represented by women (80%). Over  2⁄3 of the respondents belonged to the working-age population; the average age was 38.2±11.3 years. The most common symptoms of the acute phase of NCI were: an increase in body temperature above 38˚C, shortness of breath during physical exertion, and impaired consciousness. Most often in the post-COVID period, patients presented the following non-specific complaints: hair loss (56.6%), decreased/increased appetite (52.6%), pain in different parts of the abdomen (45.7%), fluctuations in blood pressure, the frequency of which increased with increasing age (p<0.05). The frequency of complaints about fluctuations in blood pressure and hair loss was associated with a more severe COVID-19 (p<0.05). According to the results of the neurological examination, 53.8% of the respondents had some kind of disorder related to the functioning of the structures of the central and peripheral nervous systems. The most common in people in the post-COVID period were anxiety and depressive disorders (30%), insomnia (14.6%), tension headache (13.1%), and amnesia syndrome (6.2%). Dysthymia (2.3%), migraine (2.3%), asthenic syndrome (2.3%), persistent perceptual postural dizziness (3.1%), mild cognitive impairment (1.5%), etc. were also detected. With MoCA, a significant decrease in the general state of cognitive functions was found in 7.7% of respondents in the post-COVID period. The conducted experimental psychological examination revealed the following leading violations of the higher mental functions of individuals: a decrease in long-term memory (7.7±1.7 with a norm of 8), insufficiency of the memorization process (9.2±1.1 with a norm of 10), a decrease in attention stability (1.01±0.3 with a norm of <1), significant difficulties in performing samples of spatial praxis (errors were made in 43.6%), and optical-spatial gnosis (only 5.7% coped without errors). Attention is drawn to the severity of symptoms of asthenia, which 64.9% of participants complained about after suffering COVID-19. In the results of MRI studies, the most common signs were general cortical atrophy (45%), focal changes (35%), cystic changes in the pineal body (25%), and signs of hippocampal atrophy (15%). Changes in the ratios of metabolites were noted in the MRC results – a decrease in NAA/Cr (20%), and an increase in Cho/Cr (20%), an increase in mI were noted in 10% of cases.

DISCUSSION: The results obtained within the framework of neurological and neuropsychological examination indicate the presence of a predominantly modal-nonspecific factor lesion, that is, changes in the processes of activation/inactivation of brain structures, contributing, among other things, to the occurrence of the above-mentioned anxiety and depressive states. The described disorders indicate the leading role of damage to the structures of the first block of the brain according to A.R. Luria, indicating the presence of damage in persons in the postcovid period in the area of the mediobasal cortex of the frontal lobes, hippocampus, and stem structures. In addition, imaging ultrastructural data (MRS) has the potential to be a neuromarker of manifestations of post-COVID neurological syndrome.

CONCLUSION: Post-COVID syndrome is characterized by multi-systemic manifestations, while central nervous system lesions can be attributed to the most common complications of infection caused by SARS-CoV-2. The conducted study demonstrates the high frequency and versatility of manifestations of post-COVID disorders on the part of the nervous system, regardless of the severity of the disease, which in some cases were reflected in the framework of radiological studies. Future work involves the use of complex clinical, radiological, laboratory immunological, virological and genetic techniques to search for predisposing factors, understand the mechanism of pathogenesis, and possible ways to influence and prevent the development of postcovid syndrome.