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Neurologic and psychiatric complications of SARS-CoV-2 infection are not completely understood. Only a few studies have found a relevant increase of these two categories of conditions in patients with COVID-19 who are not hospitalized. In this study, individuals with and without SARS-CoV-2 infection and diagnosis of psychiatric or neurologic disorders from March 1, 2020, to January 31, 2023, were identified using a Danish nationwide database of SARS-CoV-2 PCR test results and the Danish National Patient Registry. Focusing on the period 1 to 12 months after infection, the researchers calculated incidence rate ratios (IRRs) for new psychiatric and neurologic disorder diagnoses between SARS-CoV-2–positive and nonpositive individuals.
Among 3,239,008 individuals, 1,775,639 tested positive for SARS-CoV-2. Compared with nonpositive individuals, those who tested positive were at 24% reduced risk for any psychiatric disease in the postacute period but at slightly increased risk for a neurologic disorder. For specific disorders, the IRRs ranged widely, from a 3.9-fold increased risk for change in smell and taste to a 29% reduced risk for dementia. IRRs varied significantly with severity of infection and vaccination status but not with age, sex, or virus variant. Compared with nonpositive individuals, hospitalized COVID-19 patients were at a 2.1-fold increased risk for psychiatric disorders and a 2.4-fold increased risk for neurologic disorders.
Nielsen NM et al. SARS-CoV-2 infection and risk of postacute psychiatric and neurologic diagnoses: A nationwide Danish cohort study. Neurology 2024 Mar 12; 102:e208113. (https://doi.org/10.1212/WNL.0000000000208113)
Comment
These findings support an elevated risk for neurologic and psychiatric disorders among patients with more-severe cases of COVID-19. As the authors note, the increased risk in hospitalized patients may be more a consequence of a generalized infection, including in the central nervous system, and of the increased opportunities to diagnose sequelae during postacute hospital contacts. These new findings do not support an important postacute risk for neurologic and psychiatric disorders among those with SARS-CoV-2 infection in general.