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One-third of COVID-19 survivors received a neurologic or psychiatric diagnosis within 6 months of being infected with SARS-CoV-2, an analysis of 236,000 electronic health records showed.

Incidence of any diagnosis of a neurologic or psychiatric disorder was 33.62% (95% CI 33.17%-34.07%), according to Paul Harrison, FRCPsych, of University of Oxford in England, and co-authors.

About one in eight (12.84%, 95% CI 12.36%-13.33%) had never received a neuropsychiatric diagnosis prior to SARS-CoV-2 infection, the researchers reported in .

Anxiety (17%) and mood disorders (14%) were most common. Neurologic diagnoses such as stroke and dementia were rarer and were more likely to occur in people who had been seriously ill with COVID-19: 7% of patients admitted to intensive care had a stroke and nearly 2% were diagnosed with dementia.

"Many neurologic diagnoses were commoner after COVID-19 than after other infections or health events occurring during the same time period," Harrison told MedPage Today. "This is the first time that there are good data to show this."

"This was particularly true of COVID patients who required admission to intensive care or who had encephalitis as part of their illness," he added. While psychiatric diagnoses like anxiety and depression were common after COVID-19, "these were not strongly related to the severity of the illness," he noted.

The findings suggest there will be an increased demand for neurology, psychiatry, and primary care services, he said.

The analysis was based on electronic health records of 236,379 COVID-19 patients over age 10 in the TriNetX network, mostly people in the U.S. who were infected after January 20, 2020 and were alive on December 13. Mean age of patients was 46, and 56% were women. Nearly one-third (30%) had hypertensive disease, 9% had ischemic heart disease, 18% had other forms of heart disease, 18% were overweight or obese, 16% had type 2 diabetes, 10% had asthma, 7% had chronic kidney disease, and 19% had neoplasms.

Matched control groups included 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with any respiratory tract infection (including influenza) during the same time period. The researchers looked at 14 outcomes: intracranial hemorrhage; ischemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance misuse; and insomnia.

For outcomes that were chronic illnesses like dementia or Parkinson's disease, the research team excluded patients who had a diagnosis before the index event. For outcomes that tend to recur (including ischemic strokes and psychiatric diagnoses), they estimated separately the incidence of first diagnosis and the incidence of any diagnosis (i.e., including patients who had a diagnosis at some point before the index event).

Most neurologic or psychiatric disorders were more common in COVID-19 patients than in patients who had influenza (HR 1.44, 95% CI 1.40-1.47 for any diagnosis; HR 1.78, 95% CI 1.68-1.89 for any first diagnosis) or respiratory tract infections (HR 1.16, 95% CI 1.14-1.17 for any diagnosis; HR 1.32, 95% CI 1.27-1.36 for any first diagnosis). Sensitivity analyses comparing these results with rates of sequelae for patients with influenza in 2019 and 2018 supported the findings.

Estimated incidences in the whole COVID-19 cohort were 0.56% for intracranial hemorrhage, 2.10% for ischemic stroke, 0.11% for parkinsonism, 0.67% for dementia, 17.39% for anxiety disorder, and 1.40% for psychotic disorder, among others.

For patients admitted to intensive care, estimated incidence of any neurologic or psychiatric diagnosis was 46.42%, and for a first diagnosis was 25.79%. For ICU patients, estimated incidences were 2.66% for intracranial hemorrhage, 6.92% for ischemic stroke, 0.26% for parkinsonism, 1.74% for dementia, 19.15% for anxiety disorder, and 2.77% for psychotic disorder.

Compared with non-hospitalized patients, hospitalized COVID-19 patients generally had HRs higher than 2 for neurologic disorders like stroke, parkinsonism, Guillain-Barré syndrome, neuromuscular or muscle disease, encephalitis, and dementia. Somewhat smaller ratios emerged for psychiatric diagnoses including incident mood disorder (HR 1.53), anxiety disorder (HR 1.49), substance use disorder (HR 1.68), and insomnia (HR 1.49).

"This suggests that, although almost all neurological and psychiatric outcomes were more frequent in patients with more severe COVID-19 than in those with mild disease, these psychiatric disorders might be more driven by general effects, including psychosocial aspects of infection, rather than a direct effect of COVID-19 on the brain," observed Jonathan Rogers, MRCPsych, and Anthony David, MD, both of University College London in England, in an .

The study "points us towards the future, both in its methods and implications," the editorialists added. "Researchers need to be able to observe and anticipate the neurological and psychiatric outcomes of future emerging health threats by use of massive, international, real-world clinical data. Sadly, many of the disorders identified in this study tend to be chronic or recurrent, so we can anticipate that the impact of COVID-19 could be with us for many years."

The analysis had several limitations, Harrison and co-authors said. Completeness and accuracy of electronic health records were unknown. Many people with COVID-19 have mild or no symptoms and don't seek care, and the study most likely reflects people more severely affected by the virus. Severity and course of neurologic and psychiatric disorders were also unknown.

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