A Comparison of the Neurological and Neuropsychological Sequelae of COVID-19 Experienced by Non-ICUand ICU Treated Survivors: Results of the NeNeSCo Multicentre Prospective Cohort Study

Background: Neurological manifestations and neuroimaging data suggest an impact of COVID-19 on the brain. This may cause cognitive dysfunction, which in turn can be associated with cognitive complaints and reduced well-being. We investigated the long-term impact of COVID-19 on the brain and consequences on different levels of functioning in moderately versus severely ill hospitalized patients. Methods: This multicentre prospective cohort follow-up study recruited 101 ICU and 104 non-ICU patients admitted during the first European COVID-19 wave (March and June 2020). Patients were recruited minimally six months post-hospital discharge. Brain abnormalities (MRI), cognitive dysfunction (neuropsychological testing), neurological symptoms, cognitive complaints, and well-being (questionnaires) were compared between the ICU and non-ICU group. Data concerning comorbidity were extracted from medical files. Findings: MRI scans of ICU patients showed more microbleeds than those of non-ICU patients (ICU 61% vs. non-ICU 32%, p<0·0001). The groups did not differ in cognitive dysfunction, neurological symptoms, cognitive complaints, or well-being. The Montreal Cognitive Assessment (MoCA) screening suggested potential cognitive dysfunction in 40% of the total sample but only 12% showed a deviant multivariate cognitive profile based on a neuropsychological test battery. 62% of all patients reported having ≥ 3 cognitive complaints. 19% of patients had clinically relevant anxiety scores, 15% displayed clinically relevant depression scores, and 12% scored in the clinically relevant range for post-traumatic stress symptoms. 28% displayed clinically relevant scores on the Insomnia Severity Index. No group difference was found in presence of comorbidities. Interpretation: ICU patients had more brain abnormalities (microbleeds) on MRI scans than non-ICU patients. The clinical relevance thereof is unclear, because no other differences were found between the groups. Overall, domain-specific cognitive dysfunction was low and levels of cognitive complaints and well-being resembled those of other critically ill patients. Funding Information: This study was supported by The Brain Foundation Netherlands (grant number DR-2020-00377). Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Ethics approval was granted by the medical research ethics committee of Maastricht University Medical Centre and Maastricht University (NL75102.068.20).