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Brain Sciences
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The Post-acute COVID-19 Syndrome (PACS): What Do We Know about...
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The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurovirology".

Deadline for manuscript submissions: closed (15 August 2023) | Viewed by 15315

Special Issue Editors

Dr. Patricia Heyn

E-Mail Website
Guest Editor
Founding Director and Professor, Center for Optimal Aging, Marymount University, Arlington, VA, USA
Interests: cognitive aging; Alzheimer’s disease; mild cognitive impairment; disability; frailty; exercise training; cognitive training; socialization; cardiovascular risk factors; rehabilitation
Special Issues, Collections and Topics in MDPI journals
Dr. Preeti Zanwar

E-Mail Website1 Website2
Co-Guest Editor
Applied Health Economics & Outcomes Research, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
Interests: Alzheimer’s disease and related dementias; cancer screening and outcomes; health disparities; health economics/health services research; risk and protective factors; disability; cognitive aging; technology; short- and long-term outcomes of novel coronavirus infections and COVID-19 disease

Special Issue Information

Dear Colleagues,

The increasing evidence that severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) impacts the central nervous system (CNS) raises key questions regarding its impact on brain health and wellbeing. Health professionals are reporting an increase in neurological and behavioral symptoms, such as depression and cognitive impairment (i.e., brain fog) that could later lead to later to Parkinson’s disease, Alzheimer’s disease (AD), and related dementias. As knowledge of the science on post-acute COVID-19 syndrome (PACS) continues to build, with more findings and data illustrating its detrimental effects on human health, health outcomes, and longevity. This Special Issue will present the most current research and discuss various key symptoms and risk and protective factors, including biomarkers, race, gender, psychological, behavioral, lifestyle, contextual, cultural, and socioeconomic factors, that have been shown to be associated with PACS in various clinical populations (chronic diseases, disabilities, aging, health disparities, etc.). At this time, we are inviting contributions of novel research addressing the complex but important impact of PACS on human health with a special focus on neurological outcomes.

Please make sure to follow the best reporting practices by The EQUATOR (Enhancing the Quality and Transparency of Health Research) at https://www.equator-network.org/ and submit the appropriate reporting guideline checklist with your submission (example: https://www.equator-network.org/reporting-guidelines/strobe).

Dr. Patricia Heyn
Dr. Preeti Zanwar
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • CNS
  • brain health
  • health outcomes
  • risk factors

Published Papers (6 papers)

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18 pages, 914 KiB  
Article
Cognitive Deficits among Individuals Admitted to a Post-Acute Pneumological Rehabilitation Unit in Southern Italy after COVID-19 Infection
by Gianvito Lagravinese, Giorgio Castellana, Fabio Castellana, Maddalena Genco, Rita Petrelli, Maria Ruccia, Maria Aliani, Mauro Carone, Rodolfo Sardone and Petronilla Battista
Brain Sci. 2023, 13(1), 84; https://doi.org/10.3390/brainsci13010084 - 01 Jan 2023
Cited by 3 | Viewed by 1992
Abstract
(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 [...] Read more.
(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 male, median age 67.5) consisted of patients who received non-invasive mechanical ventilation; Group-2 (n = 19; 16 male, median age 63) consisted of patients who received invasive mechanical ventilation. All patients underwent a neuropsychological assessment including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS) to evaluate the patients’ cognition. Depression and anxiety were also measured at admission and discharge to rehabilitation. (3) Results: At admission, patients impaired at MMSE were 44% in Group-1 and 5% in Group-2, while patients impaired at FAB were 88% in Group-1 and 26% in Group-2. Wilcoxon’s effect size revealed meaningful differences between groups for FAB, R-BANS global score, immediate and delayed memory, and attention-coding task, with Group-2 performing better than Group-1 across all measures. At discharge, 52% of the 25 patients re-assessed still had mild to moderate cognitive deficits, while 19% had depression and 35% had anxiety. (4) Conclusions: Patients who received oxygen therapy experienced higher levels of acute and chronic stress compared to those who benefitted from invasive mechanical ventilation. Despite patients showing a meaningful improvement at discharge, cognitive impairment persisted in a great number of patients; therefore, long-term neuropsychological follow-up and treatment for COVID-19 patients are recommended. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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13 pages, 2822 KiB  
Communication
Examining Association of Personality Characteristics and Neuropsychiatric Symptoms in Post-COVID Syndrome
by Cristina Delgado-Alonso, María Valles-Salgado, Alfonso Delgado-Álvarez, Natividad Gómez-Ruiz, Miguel Yus, Carmen Polidura, Carlos Pérez-Izquierdo, Alberto Marcos, María José Gil, Jorge Matías-Guiu and Jordi A. Matias-Guiu
Brain Sci. 2022, 12(2), 265; https://doi.org/10.3390/brainsci12020265 - 14 Feb 2022
Cited by 7 | Viewed by 3291
Abstract
Background: We aimed to evaluate personality traits in patients with post-COVID syndrome, as well as the association with neuropsychiatric symptoms present in this disorder. Methods: The Big Five Structure Inventory was administered to 93 consecutive patients with a diagnosis of post-COVID syndrome as [...] Read more.
Background: We aimed to evaluate personality traits in patients with post-COVID syndrome, as well as the association with neuropsychiatric symptoms present in this disorder. Methods: The Big Five Structure Inventory was administered to 93 consecutive patients with a diagnosis of post-COVID syndrome as defined by the WHO and to demographically matched controls. We also performed a comprehensive evaluation of depression, anxiety, fatigue, sleep quality, cognitive function, and olfactory function. Results: Patients with post-COVID syndrome scored lower for emotional stability, equanimity, positive mood, and self-control. Extraversion, emotional stability, and openness correlated negatively with anxiety and depression levels. Conscientiousness correlated negatively with anxiety. No statistically significant correlations were observed between personality traits and cognitive function, sleep quality, olfactory function, or fatigue. Personality scores explained 36.3% and 41% of the variance in scores on the anxiety and depression scales, respectively. Two personality profiles with lower levels of emotional stability were associated with depression and anxiety. Conclusions: Our study shows higher levels of neuroticism in patients with post-COVID syndrome. Personality traits were predictive of the presence of depression and anxiety, but not cognitive function, sleep quality, or fatigue, in the context of post-COVID syndrome. These findings may have implications for the detection of patients at risk of depression and anxiety in post-COVID syndrome, and for the development of preventive and therapeutic interventions. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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10 pages, 1701 KiB  
Brief Report
The Relationship between Paresthesia and the Presence of Cardiac Dysautonomia in Patients with Post-COVID-19 Syndrome: A Preliminary Observational Study
by Erislandis López-Galán, Arquímedes Montoya-Pedrón, Miguel Enrique Sánchez-Hechavarría, Mario Eugenio Muñoz-Bustos and Gustavo Alejandro Muñoz-Bustos
Brain Sci. 2023, 13(7), 1095; https://doi.org/10.3390/brainsci13071095 - 20 Jul 2023
Cited by 1 | Viewed by 1471
Abstract
Introduction: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac [...] Read more.
Introduction: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac dysautonomia in patients with post-COVID-19 syndrome is the objective of this study. Participants and Methods: This observational study was carried out in the neurophysiology service wing of the Juan Bruno Zayas Hospital, Santiago de Cuba, in Cuba. The patients were recruited through a post-COVID-19 clinic at the same hospital. A variability study of cardiac frequency and a test of autonomic cardiovascular reflexes was carried out, which is composed of deep breathing, orthostatism, and the Valsalva maneuver. Results: The variability parameters of the cardiac frequency, the expiration–inspiration ratio between deep breaths, and the Valsalva Index showed no statistically significant differences between healthy participants and those with post-COVID-19 syndrome. During the Valsalva maneuver, there was a greater cardiac frequency response in participants with post-COVID-19 syndrome than in healthy subjects. The difference in supine and standing blood pressure was significantly minor in patients with post-COVID-19 syndrome. The logarithm of high frequency (log HF) increased significantly in patients with paresthesia when compared to patients without paresthesia. Conclusions: In the autonomic function tests, no signs of dysautonomia were found in patients with post-COVID-19 syndrome. The presence of paresthesias is associated with differences in cardiac vagal activity, which may suggest that damage to peripheral sensory nerve fibers could be associated with an affectation to autonomic fibres. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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10 pages, 658 KiB  
Brief Report
Cognitive Difficulties, Psychological Symptoms, and Long Lasting Somatic Complaints in Adolescents with Previous SARS-CoV-2 Infection: A Telehealth Cross-Sectional Pilot Study
by Samuela Tarantino, Sonia Graziano, Chiara Carducci, Rosaria Giampaolo and Teresa Grimaldi Capitello
Brain Sci. 2022, 12(8), 969; https://doi.org/10.3390/brainsci12080969 - 23 Jul 2022
Cited by 8 | Viewed by 2226
Abstract
Background. Few studies have evaluated cognitive functioning and mental health in children and adolescents who contracted the SARS-CoV-2 infection. We investigated the prevalence and association of neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints in a sample of adolescents. Methods. Thirty-one adolescents infected [...] Read more.
Background. Few studies have evaluated cognitive functioning and mental health in children and adolescents who contracted the SARS-CoV-2 infection. We investigated the prevalence and association of neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints in a sample of adolescents. Methods. Thirty-one adolescents infected by COVID-19 within 3–6 months prior to the assessment were included. Neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints were evaluated using a checklist and a battery of multiple standardized measures, using a telehealth procedure. Symptoms during the infection were also detected. Results. We included 31 adolescents (23 girls, 8 boys; mean age 14.1, SD = 2). We found borderline scores in 32.3% and 45.2% of our sample for phonemic and category fluency, respectively. A high percentage of participants showed symptoms of depression (80.6%) and anxiety (61.3%). Fifty-eight percent reported at least one long-COVID symptom. The most common symptoms were headache and attention problems (58%). Subjects presenting numbness/weakness, fatigue, brain fog, or attention problems had higher scores in depression, anxiety, and post-traumatic stress symptoms (p ≤ 0.05). Conclusion. This is a pilot study limited by the lack of control group. However, we found that cognitive, psychological, and physical symptoms were very common among adolescents recovered from COVID-19. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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7 pages, 1629 KiB  
Case Report
A Case Report of Posterior Reversible Encephalopathy Syndrome (PRES) in a Nonsevere Case of COVID-19
by Małgorzata Cisowska-Adamiak, Katarzyna Sakwińska, Iwona Szymkuć-Bukowska, Anna Goclik, Iwona Lunitz and Magdalena Mackiewicz-Milewska
Brain Sci. 2022, 12(7), 915; https://doi.org/10.3390/brainsci12070915 - 13 Jul 2022
Cited by 2 | Viewed by 1538
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare complication that the exact pathophysiological mechanism of which is still unclear. PRES most often occurs in connection with severe hypertension and autoimmune diseases. It can also appear during chemotherapy or immunosuppressive treatment. A 38-year-old woman [...] Read more.
Posterior reversible encephalopathy syndrome (PRES) is a rare complication that the exact pathophysiological mechanism of which is still unclear. PRES most often occurs in connection with severe hypertension and autoimmune diseases. It can also appear during chemotherapy or immunosuppressive treatment. A 38-year-old woman with a negative medical history was admitted to the local hospital due to loss of consciousness accompanied by seizures and high values of blood pressure, and a PCR test for COVID-19 was positive. The patient’s condition was preceded by weakness, wet cough, runny nose, and low-grade fever for three days. Due to the conducted diagnostics after negative CT scans and angio CT studies, an MRI of the head with contrast was performed, where changes characteristic of PRES syndrome were found. During the hospitalization, the patient did not require invasive ventilation and did not receive antiviral drugs or tocilizumab as a result of treatment for her high blood pressure values, and after establishing the diagnosis, the patient was discharged home with a significant improvement in her well-being. In the literature, there are discussions as to whether COVID-19 predisposes patients to PRES. Isolated cases have been described, but its frequency is not yet established. Case reports in the literature appear to be specifically associated with a severe course of the disease, unlike in our patient. Even with a mild course of COVID, the diagnosis of PRES should be taken into account in patients with seizures, visual disturbances, or other focal neurological deficits. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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12 pages, 774 KiB  
Case Report
Neuropsychiatric Disorders in Pediatric Long COVID-19: A Case Series
by Rosa Savino, Anna N. Polito, Giulia Arcidiacono, Mariacristina Poliseno and Sergio Lo Caputo
Brain Sci. 2022, 12(5), 514; https://doi.org/10.3390/brainsci12050514 - 19 Apr 2022
Cited by 14 | Viewed by 3337
Abstract
Few data are available regarding the incidence and the evolution of neuropsychiatric manifestations in children with a history of COVID-19. We herein report five consequent cases of pediatric patients with psychiatric and neurological symptoms of long COVID-19. All patients, mainly males, reported asymptomatic-to-mild [...] Read more.
Few data are available regarding the incidence and the evolution of neuropsychiatric manifestations in children with a history of COVID-19. We herein report five consequent cases of pediatric patients with psychiatric and neurological symptoms of long COVID-19. All patients, mainly males, reported asymptomatic-to-mild COVID-19 and underwent home self-isolation. Abnormal movements, anxiety, and emotional dysregulation were the most recurrent symptoms observed from a few weeks to months after the resolution of the acute infection. A later onset was observed in younger patients. Blood tests and brain imaging resulted in negative results in all subjects; pharmacological and cognitive behavioral therapy was set. A multifactorial etiology could be hypothesized in these cases, as a result of a complex interplay between systemic and brain inflammation and environmental stress in vulnerable individuals. Longer follow-up is required to observe the evolution of neuropsychiatric manifestation in the present cohort and other young patients with previous SARS-CoV-2 infection. Full article
(This article belongs to the Special Issue The Post-acute COVID-19 Syndrome (PACS): What Do We Know about Its Impact on Brain Health & Health Outcomes)
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