Written by Courtney Coleman, Edited by LisaMichelle Pecaro
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The many effects of COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, remain the subject of much interest as it continues to impact the lives of millions worldwide. As of this writing, global cases of COVID-19 have surpassed 167 million, with more than 3.4 million deaths, and while most patients who contract COVID-19 fully recover, others suffer from persistent symptoms and longstanding complications.
Due to the multitude of symptoms experienced by COVID-19 patients, it has become apparent that COVID-19 affects various organ systems, and researchers are currently working to determine why this is occurring; however, the exact extent of the long-term impacts of contracting this illness remains unknown, and further research is needed in order to ascertain the significance of the long-term repercussions the current global pandemic will have on survivors.
One area of research has been focused on determining the neuropsychiatric effects of COVID-19, a particularly interesting and critical topic to explore due to the fact that SARS-CoV-2 is considered to be a neurotropic virus, meaning that it can enter nerve cells and affect the nervous system. Consequently, the behavior of the SARS-CoV-2 virus is leading to the observation of a variety of neuropsychiatric symptoms presented by COVID-19 patients, including migraine-like headaches that are resistant to traditional pain relieving medications, confusion, hallucinations, delirium, depression, anxiety, sleep problems, and encephalitis, to name a few. Guillain-Barré syndrome, an autoimmune disorder that attacks the nerves, has also been observed.
The first indications that COVID-19 could affect the nervous system occurred with the initial reports of patients experiencing a loss of their sense of smell, and as cases of COVID-19 continued to increase, additional complications became more commonly reported, such as strokes, as well as other neurological complications. Currently, it is thought that a number of distinct contributing factors play a role in developing neuropsychiatric complications, such as hospitalization in the intensive care unit (ICU), inflammatory or immune responses, strokes, viral infections within the brain, damage to neural and glial cells, acute respiratory distress syndrome, as well as therapeutics and invasive techniques used for sedation and ventilation. Researchers have also discovered that COVID-19 can lead to blood vessel inflammation, leakage, and small clots within the brain, and it is thought that this, in addition to the ways in which SARS-CoV-2 binds to ACE2 receptors on cell membranes, may further contribute to the development of neuropsychiatric complications. This is due to the fact that ACE2 receptors are highly concentrated in the olfactory bulb, the area of the brain responsible for receiving sensations of smell, and this section is also strongly connected to the hippocampus, the area of the brain that is responsible for memory. Consequently, researchers have hypothesized that this pathway may be the cause of the cognitive impairments observed in COVID-19 patients, and they also believe that this pathway may make it possible for patients who were asymptomatic, or who experienced only mild symptoms, to experience neuropsychiatric complications in the future, particularly since there is research supporting the potential connection between contracting illnesses that are flu-like and an elevated risk of Alzheimer’s disease, Parkinson’s disease, and mental health problems.
The exact incidence of neuropsychiatric complications remains the focus of much research, and a study published in The Lancet Psychiatry on May 1, 2021, reported that, in their analysis of 236,379 COVID-19 survivors, the incidence, or new cases, of a neurological or psychiatric diagnosis was nearly 34%, or one in three, within the six months following a diagnosis of COVID-19. Nearly 13% of this patient population was diagnosed with one of these disorders for the first time. When analyzing only those patients who has been hospitalized in the ICU, the percentage of those receiving a neurological or psychiatric diagnosis increased to slightly over 46%, with nearly 26% acquiring a first diagnosis. Within the overall analysis of COVID-19 survivors, as well as the analysis conducted on the ICU group, the most common diagnosis was anxiety, followed by ischemic stroke, and then psychotic disorder. Severe COVID-19 patients, in general, experienced the greatest risk for neuropsychiatric complications.
While a variety of helpful information has been discovered, there remains the need for additional research in order to determine the degree of the complications COVID-19 has on all organs affected; however, regarding brain health specifically, there remains a particular need to investigate the neuropsychiatric effects in younger age populations, as well as in asymptomatic or mildly symptomatic patients, in order to evaluate the extent of which this pandemic will have lasting effects on patient health.
Results from ongoing research and the current understanding of COVID-19 are constantly evolving. This post contains information that was last updated on May 29th, 2021