Brain MRI and neuropsychological findings at long-term follow-up after COVID-19 hospitalisation: an observational cohort study

Research Objectives: To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system.

Design: Ambidirectional observational cohort study.

Setting: All patients (n=734) previously hospitalized with a laboratory-confirmed COVID-19 in a total regional population in Sweden during the period March 1st to May 31st 2020.

Participants: A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI.

Interventions: n.a.

Main Outcome Measures: Findings on brain MRI, neurocognitive test results and reported fatigue.

Results: Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Six patients had had MRI performed in the acute phase during their hospitalisation, and all of these patients had additional white matter lesions at the follow-up MRI. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings.

Conclusions: A majority in this group of patients selected to undergo MRI after a clinical evaluation, showed signs of possible COVID-19 related brain affection detectable by brain MRI and/or neurocognitive test results. Even in a previously fairly healthy group of patients, COVID-19 might have a substantial negative impact on cognition in several domains, persisting several months post discharge. Abnormal findings were not restricted to patients with severe disease. Thus, for clinicians it is important to consider post-covid related changes when facing patients’ reports of neuropsychological deficiency, regardless of severity of disease.

Author(s) Disclosures: The authors declare no competing interests