Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury
Author:
Taquet Maxime12, Skorniewska Zuzanna1, Zetterberg Henrik345678ORCID, Geddes John R12, Mummery Catherine J5, Chalmers James D9, Ho Ling-Pei10, Horsley Alex1112, Marks Michael131415ORCID, Poinasamy Krisnah16, Raman Betty1718ORCID, Leavy Olivia C19, Richardson Matthew20, Elneima Omer20, McAuley Hamish J C20, Shikotra Aarti21, Singapuri Amisha20, Sereno Marco20, Saunders Ruth M20, Harris Victoria Claire2022, Houchen-Wolloff Linzy232425, Mansoori Parisa26, Greening Neil J20, Harrison Ewen M27, Docherty Annemarie B27, Lone Nazir I2829, Quint Jennifer30, Greenhalf William313233, Wain Louise V1920, Brightling Christopher E20, Evans Rachael E2022, Harrison Paul J12ORCID, Koychev Ivan1ORCID, Brightling C E, Evans R A, Wain L V, Chalmers J D, Harris V C, Ho L P, Horsley A, Marks M, Poinasamy K, Raman B, Shikotra A, Singapuri A, Brightling C E, Evans R A, Wain L V, Dowling R, Edwardson C, Elneima O, Finney S, Greening N J, Hargadon B, Harris V, Houchen--Wolloff L, Leavy O C, McAuley H J C, Overton C, Plekhanova T, Saunders R M, Sereno M, Singapuri A, Shikotra A, Taylor C, Terry S, Tong C, Zhao B, Lomas D, Sapey E, Berry C, Bolton C E, Brunskill N, Chilvers E R, Djukanovic R, Ellis Y, Forton D, French N, George J, Hanley N A, Hart N, McGarvey L, Maskell N, McShane H, Parkes M, Peckham D, Pfeffer P, Sayer A, Sheikh A, Thompson A A R, Williams N, Brightling C E, Greenhalf W, Semple M G, Ashworth M, Hardwick H E, Lavelle-Langham L, Reynolds W, Sereno M, Saunders R M, Singapuri A, Shaw V, Shikotra A, Venson B, Wain L V, Docherty A B, Harrison E M, Sheikh A, Baillie J K, Brightling C E, Daines L, Free R, Evans R A, Kerr S, Leavy O C, Lone N I, McAuley H J C, Pius R, Quint J, Richardson M, Sereno M, Thorpe M, Wain L V, Halling-Brown M, Gleeson F, Jacob J, Neubauer S, Raman B, Siddiqui S, Wild J M, Aslani S, Jezzard P, Lamlum H, Lilaonitkul W, Tunnicliffe E, Willoughby J, Wain L V, Baillie J K, Baxendale H, Brightling C E, Brown M, Chalmers J D, Evans R A, Gooptu B, Greenhalf W, Hardwick H E, Jenkins R G, Jones D, Koychev I, Langenberg C, Lawrie A, Molyneaux P L, Shikotra A, Pearl J, Ralser M, Sattar N, Saunders R M, Scott J T, Shaw T, Thomas D, Wilkinson D, Heaney L G, De Soyza A, Adeloye D, Brightling C E, Brown J S, Busby J, Chalmers J D, Echevarria C, Daines L, Elneima O, Evans R A, Hurst J, Novotny P, Pfeffer P, Poinasamy K, Quint J, Rudan I, Sapey E, Shankar-Hari M, Sheikh A, Siddiqui S, Walker S, Zheng B, Geddes J R, Hotopf M, Abel K, Ahmed R, Allan L, Armour C, Baguley D, Baldwin D, Ballard C, Bhui K, Breen G, Broome M, Brugha T, Bullmore E, Burn D, Callard F, Cavanagh J, Chalder T, Clark D, David A, Deakin B, Dobson H, Elliott B, Evans J, Francis R, Guthrie E, Harrison P, Henderson M, Hosseini A, Huneke N, Husain M, Jackson T, Jones I, Kabir T, Kitterick P, Korszun A, Koychev I, Kwan J, Lingford-Hughes A, Mansoori P, McAllister-Williams H, McIvor K, Milligan L, Morriss R, Mukaetova-Ladinska E, Munro K, Nevado-Holgado A, Nicholson T, Paddick S, Pariante C, Pimm J, Saunders K, Sharpe M, Simons G, Upthegrove R, Wessely S, McCann G P, Amoils S, Antoniades C, Banerjee A, Bell R, Bularga A, Berry C, Chowienczyk P, Greenwood J P, Hughes A D, Khunti K, Kingham L, Lawson C, Mangion K, Mills N L, Moss A J, Neubauer S, Raman B, Sattar A N, Sudlow C L, Toshner M, Openshaw P J M, Altmann D, Baillie J K, Batterham R, Baxendale H, Bishop N, Brightling C E, Calder P C, Evans R A, Heeney J L, Hussell T, Klenerman P, Lord J M, Moss P, Rowland-Jones S L, Schwaeble W, Semple M G, Thwaites R S, Turtle L, Wain L V, Walmsley S, Wraith D, Rowland M J, Rostron A, Baillie J K, Connolly B, Docherty A B, Lone N I, McAuley D F, Parekh D, Rostron A, Simpson J, Summers C, Jenkins R G, Porter J, Allen R J, Aul R, Baillie J K, Barratt S, Beirne P, Blaikley J, Chambers R C, Chaudhuri N, Coleman C, Denneny E, Fabbri L, George P M, Gibbons M, Gleeson F, Gooptu B, Guio B Guillen, Hall I, Hanley N A, Ho L P, Hufton E, Jacob J, Jarrold I, Jenkins G, Johnson S, Jones M G, Jones S, Khan F, Mehta P, Mitchell J, Molyneaux P L, Pearl J E, Hanley K Piper, Poinasamy K, Quint J, Parekh D, Rivera-Ortega P, Saunders L C, Semple M G, Simpson J, Smith D, Spears M, Spencer L G, Stanel S, Stewart I, Thompson A A R, Thickett D, Thwaites R, Wain L V, Walker S, Walsh S, Wild J M, Wootton D G, Wright L, Heller S, Davies M J, Atkins H, Bain S, Dennis J, Ismail K, Johnston D, Kar P, Khunti K, Langenberg C, McArdle P, McGovern A, Peto T, Petrie J, Robertson E, Sattar N, Shah K, Valabhji J, Young B, Howard L S, Toshner Mark, Berry C, Chowienczyk P, Lasserson D, Lawrie A, Leavy O C, Mitchell J, Price L, Quint J, Rossdale J, Sattar N, Sudlow C, Thompson A A R, Wild J M, Wilkins M, Singh S J, Man W D-C, Lord J M, Greening N J, Chalder T, Scott J T, Armstrong N, Baldry E, Baldwin M, Basu N, Beadsworth M, Bishop L, Bolton C E, Briggs A, Buch M, Carson G, Cavanagh J, Chinoy H, Daynes E, Defres S, Evans R A, Greenhaff P, Greenwood S, Harvie M, Husain M, MacDonald S, 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Affiliation:
1. Department of Psychiatry, University of Oxford , Oxford OX3 7JX , UK 2. Oxford Health NHS Foundation Trust , Oxford OX3 7JX , UK 3. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Mölndal 413 90 , Sweden 4. Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal 413 90 , Sweden 5. Department of Neurodegenerative Disease, UCL Institute of Neurology , London WC1N 3BG , UK 6. UK Dementia Research Institute at UCL , London WC1N 3BG , UK 7. Hong Kong Center for Neurodegenerative Diseases , Hong Kong , China 8. Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison , Madison, WI 53792 , USA 9. University of Dundee, Ninewells Hospital and Medical School , Dundee DD1 9SY , UK 10. MRC Human Immunology Unit, University of Oxford , Oxford OX3 9DS , UK 11. Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester , Manchester M13 9PL , UK 12. Manchester University NHS Foundation Trust , Manchester M13 9WL , UK 13. Department of Clinical Research, London School of Hygiene & Tropical Medicine , London WC1E 7HT , UK 14. Hospital for Tropical Diseases, University College London Hospital , London WC1E 6JD , UK 15. Division of Infection and Immunity, University College London , London WC1E 6BT , UK 16. Asthma and Lung UK , London E1 8AA , UK 17. Radcliffe Department of Medicine, University of Oxford , Oxford OX3 9DU , UK 18. Oxford University Hospitals NHS Foundation Trust , Oxford OX3 9DU , UK 19. Department of Population Health Sciences, University of Leicester , Leicester LE1 7RH , UK 20. The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester , Leicester LE3 9QP , UK 21. NIHR Leicester Biomedical Research Centre, University of Leicester , Leicester LE5 4PW , UK 22. University Hospitals of Leicester NHS Trust , Leicester LE5 4PW , UK 23. Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester , Leicester LE5 4PW , UK 24. Department of Respiratory Sciences, University of Leicester , Leicester LE1 9HN , UK 25. Therapy Department, University Hospitals of Leicester, NHS Trust , Leicester LE5 4PW , UK 26. MQ: Transforming Mental Health , London EC1Y 0TH , UK 27. Centre for Medical Informatics, The Usher Institute, University of Edinburgh , Edinburgh EH16 4SS , UK 28. Usher Institute, University of Edinburgh , Edinburgh EH16 4SS , UK 29. Royal Infirmary of Edinburgh, NHS Lothian , Edinburgh EH16 4SA , UK 30. , Imperial College London National Heart and Lung Institute , London SW3 6LY , UK 31. University of Liverpool , Liverpool L69 3BX , UK 32. The CRUK Liverpool Experimental Cancer Medicine Centre , Liverpool L69 3GL , UK 33. Liverpool University Hospitals NHS Foundation Trust , Liverpool L7 8YE , UK
Abstract
Abstract
A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury.
Funder
UK Research and Innovation MQ Mental Health Research Wolfson Foundation National Institute for Health and Care Research Oxford Health Biomedical Research Centre Swedish Research Council European Union’s Horizon Europe research and innovation programme Swedish State Support for Clinical Research Alzheimer Drug Discovery Foundation Alzheimer’s Disease Strategic Fund Alzheimer’s Association Olav Thon Foundation Erling-Persson Family Foundation Stiftelsen för Gamla Tjänarinnor Hjärnfonden, Sweden Marie Skłodowska-Curie European Union Joint Programme—Neurodegenerative Disease Research UK Dementia Research Institute at University College London Medical Research Council Oxford Health NIHR Biomedical Research Centre
Publisher
Oxford University Press (OUP)
Subject
Neurology,Cellular and Molecular Neuroscience,Biological Psychiatry,Psychiatry and Mental health
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