Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series

Author(s):Show less -

Brasil Matos, Aline de Moura ^[1] ; Dahy, Flavia Esper ^[2] ; Luisi de Moura, Joao Victor ^[2] ; Nascimento Marcusso, Rosa Maria ^[2] ; Ferreira Gomes, Andre Borges ^{[3, 4]} ; Maia Carvalho, Fernanda Martins ^{[3, 4]} ; Peres Fernandes, Gustavo Bruniera ^[5] ; Felix, Alvina Clara ^[1] ; Smid, Jerusa ^[2] ; Vidal, Jose Ernesto ^{[2, 1]} ; Ferreira Frota, Norberto Anizio ^{[3, 4]} ; Casseb, Jorge ^[1] ; Easton, Ava ^{[6, 7]} ; Solomon, Tom ^{[8, 9]} ; Witkin, Steven S. ^{[10, 1]} ; Romano, Camila Malta ^{[1, 11]} ; Penalva de Oliveira, Augusto Cesar ^[2] ; Grp, NeuroCovBR Study

Affiliation:Show less -

^[1] Univ Sao Paulo, Fac Med, Inst Med Trop, Sao Paulo - Brazil

^[2] Inst Infectol Emilio Ribas, Sao Paulo - Brazil

^[3] Hosp Geral Fortaleza, Serv Neurol, Fortaleza, Ceara - Brazil

^[4] Univ Fortaleza, Programa Posgrad Ciencias Med, Fortaleza, Ceara - Brazil

^[5] Hosp Israelita Albert Einstein, Sao Paulo - Brazil

^[6] Encephalitis Soc, Malton - England

^[7] Univ Liverpool, Dept Clin Infect Microbiol & Immunol, Liverpool, Merseyside - England

^[8] Univ Liverpool, Inst Infect Vet & Ecol Sci, Natl Inst Hlth Res, Hlth Protect Unit Emerging & Zoonot Infect, Liverpool, Merseyside - England

^[9] Walton Ctr Natl Hlth Serv Fdn Trust, Liverpool, Merseyside - England

^[10] Weill Cornell Med, Dept Obstet & Gynecol, New York, NY - USA

^[11] Univ Sao Paulo, Hosp Clin, Fac Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: FRONTIERS IN NEUROLOGY; v. 12, AUG 4 2021.
• Web of Science Citations: 0

Abstract

Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances. Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed >7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT). Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15-33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25-10.75) and altered visuospatial construction with a median of four points (IQR 4-9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-Co Conclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19. (AU)

• FAPESP's process: 19/03859-9 - Clinical, serological and virological characteristics of Dengue virus serotype 2 (DENV-2) infection in a cohort previously exposed to serotype 1
• Grantee: Camila Malta Romano
• Support Opportunities: Regular Research Grants
• FAPESP's process: 20/05984-2 - Acute neurological manifestations associated with SARS-CoV-2 virus
• Grantee: Jorge Simao do Rosario Casseb
• Support Opportunities: Regular Research Grants