A new survey reveals a wide range of serious psychiatric and neurological complications tied to Covid-19 — including stroke, psychosis, and a dementia-like syndrome. The study underscores how aggressively the coronavirus can attack beyond the lungs, and the risk the disease can pose to younger adults.
The study looked at 125 hospitalized patients with Covid-19 who also had some sort of neuropsychiatric complication. Fifty-seven had had an ischemic stroke, caused by a blood clot in the brain. The second most common issue, affecting 39 patients, was an altered mental state, researchers reported. That included encephalitis (an inflammation of the brain that can cause a number of symptoms, from confusion to mobility problems) and encephalopathy (a general term for a disease that alters brain function). Ten patients were newly diagnosed with psychosis, and six had cognitive issues akin to dementia, according to the study, published in the Lancet Psychiatry.
“What was particularly interesting was that this spanned the neurological spectrum,” said senior author Benedict Michael of the University of Liverpool, a neurologist specializing in infectious diseases.
The people in the study ranged from their 20s to their 90s, and the researchers noted that, because they focused on hospitalized patients, the complications detailed likely represent the most serious ones.
Whereas the strokes were more common among older patients, the researchers found that about half of those who experienced altered mental status were younger than 60.
Smaller studies and case reports from China and other European countries had raised the connection between Covid-19 and neuropsychiatric complications, but for the new study, the researchers set out to get a full picture of the range of those complications. To amass as broad a data set as possible, they built a reporting network across the United Kingdom that enlisted specialists in stroke, neurology, psychiatry, and critical care.
“Everybody is focused on mortality, which they should, and respiratory problems, which is the main cause of death,” said Mark George, a psychiatrist and neurologist at the Medical University of South Carolina, who was not involved with the study. But, George said, “the virus certainly does have brain effects.”
As the pandemic has spread around the globe, clinicians have found themselves treating complications in just about every bodily system as a result of Covid-19 — including diabetes, kidney damage, even lesions on people’s toes. With some of these, it’s thought that because there are so many global cases occurring so quickly, doctors are able to notice enough rare occurrences to make a connection.
But with complications in the brain, experts are still trying to figure out exactly how rare they are. The more severe problems might occur infrequently, but scientists and doctors were clued into the virus’ targeting of the nervous system early on, when a loss of smell and taste became one of the more common symptoms of the inscrutable virus. Many patients have also reported fatigue, depression, and anxiety.
It’s unclear exactly what’s causing each neuropsychiatric issue: the viral infection itself; the body’s immune response, which is responsible for other, sometimes fatal complications following infections; or a combination of the two. (The study also noted that altered mental status is not uncommon in people admitted to the hospital with severe infections generally, especially those who require intensive care.)
“This actually is a direct effect, in some people, of the virus going into brains,” George said.
It’s long been known that viral infections can cause lasting neurological complications; the 1918 flu pandemic was similarly associated with encephalitis in some patients. But Michael, the new study’s senior author, said the Covid-19 pandemic presented an opportunity for scientists to discover how a virus can cause those complications, given how widespread the coronavirus is and the new technology researchers have.
What remains unknown is how long these complications — or sequelae, in science-speak — may last for people with Covid-19. Michael said the research team was working to follow the patients in the study.
“Ask me in six months and then we will have some degree of a handle on it.”