Cognitive impairment and a ered cerebral glucose metabolism in the subacute stage of COVID-19
Cognitive impairment and a ered cerebral glucose metabolism in the subacute stage of COVID-19
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DOI：
10.1093/brain/awab009
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发表时间：
2021-04-03
期刊：
影响因子：
14.5
通讯作者：
Meyer, Philipp T.
中科院分区：
文献类型：
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作者：
Hosp, Jonas A.;Dressing, Andrea;Meyer, Philipp T.
在严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）大流行期间，神经系统症状日益成为人们关注的焦点。在这项前瞻性队列研究中，我们评估了住院的冠状病毒病-19 （COVID-19）患者的神经和认知症状，旨在确定其神经元相关性。在2020年4月20日至2020年5月12日期间，对主要因非神经系统并发症而需要住院治疗的经逆转录pcr确诊的COVID-19感染患者进行了筛查。当出现至少一种新的神经症状（定义为味觉和/或嗅觉受损，蒙特利尔认知评估表现< 26分和/或临床神经学检查的病理结果）时，患者（年龄在bb0 - 18岁）被纳入我们的队列。一旦感染不再存在，>= 2新症状的患者有资格使用综合神经心理测试、脑MRI和（18）氟脱氧葡萄糖（FDG） PET进行进一步诊断。排除标准为：病前诊断认知障碍、神经退行性疾病或重症监护病房治疗。在筛选的41例COVID-19住院患者中，29例（65.2 +/- 14.4岁，38%为女性）亚急性期纳入登记册。最常见的是29/29和25/29患者的味觉和嗅觉受到干扰。蒙特利尔认知评估中有18/26的患者表现受损（平均得分21.8/30），重点是额顶叶认知功能受损。对15名患者进行了详细的神经心理学测试，证实了这一点。（18）FDG PET显示10/15例以额顶叶代谢低下为主的患者病理结果。使用体素为主成分分析与对照样本进行比较，证实了这一模式，显示出与蒙特利尔认知评估表现的高度相关性（R-2 = 0.62）。一名患者的尸检显示白质小胶质细胞激活，但没有神经炎症的迹象。在最初需要住院治疗的亚急性COVID-19患者中检测到相应比例的新皮质功能障碍伴认知能力下降。这具有重大的康复和社会经济意义。
During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, neurological symptoms increasingly moved into the focus of interest. In this prospective cohort study, we assessed neurological and cognitive symptoms in hospitalized coronavirus disease-19 (COVID-19) patients and aimed to determine their neuronal correlates. Patients with reverse transcription-PCR-confirmed COVID-19 infection who required inpatient treatment primarily because of non-neurological complications were screened between 20 April 2020 and 12 May 2020. Patients (age > 18 years) were included in our cohort when presenting with at least one new neurological symptom (defined as impaired gustation and/or olfaction, performance < 26 points on a Montreal Cognitive Assessment and/or pathological findings on clinical neurological examination). Patients with >= 2 new symptoms were eligible for further diagnostics using comprehensive neuropsychological tests, cerebral MRI and (18)fluorodeoxyglucose (FDG) PET as soon as infectivity was no longer present. Exclusion criteria were: premorbid diagnosis of cognitive impairment, neurodegenerative diseases or intensive care unit treatment. Of 41 COVID-19 inpatients screened, 29 patients (65.2 +/- 14.4 years; 38% female) in the subacute stage of disease were included in the register. Most frequently, gustation and olfaction were disturbed in 29/29 and 25/29 patients, respectively. Montreal Cognitive Assessment performance was impaired in 18/26 patients (mean score 21.8/30) with emphasis on frontoparietal cognitive functions. This was confirmed by detailed neuropsychological testing in 15 patients. (18)FDG PET revealed pathological results in 10/15 patients with predominant frontoparietal hypometabolism. This pattern was confirmed by comparison with a control sample using voxel-wise principal components analysis, which showed a high correlation (R-2 = 0.62) with the Montreal Cognitive Assessment performance. Post-mortem examination of one patient revealed white matter microglia activation but no signs of neuroinflammation. Neocortical dysfunction accompanied by cognitive decline was detected in a relevant fraction of patients with subacute COVID-19 initially requiring inpatient treatment. This is of major rehabilitative and socioeconomic relevance.