Neurological diseases have been a growing global problem not only since the COVID-19 pandemic - but are increasingly observed after these infections as a consequence of post-COVID or long-COVID. For this reason, neuro-COVID also played an important role at the 2nd Yuvedo Online Conference1 on 10 June 2021. The consensus of the speakers was: The time to prevent another pandemic after this pandemic is now!
After a short introduction by Daniel Finger, Radio Berlin Brandenburg (Germany) moderator, trainer and coach, and Dr. Jörg Karenfort, Co-Founder and CEO of the YUVEDO Foundation, the thematic introduction to the conference programme was provided by Prof. Dr. Jens Volkmann.
Under the title "Time of awakening - avoiding the pandemic after the pandemic", the head of the Parkinson's Clinic at the University of Würzburg (Germany) pointed out the seriousness of the situation. According to Dr. Volkmann, neuro-COVID could gain immense clinical and economic importance in the future. In his lecture, the physician refered to a study by Harrison et al.2 published in May 2021 in The Lancet Psychiatry among 236,379 US patients with diagnosed COVID-19 disease.
The hard numbers: The incidence of new neurological or psychiatric diagnoses within 6 months of infection was 33.62%, including 12.84% first diagnoses. After intensive care treatment, the incidence was 46.42%, and after acute COVID-related encephalopathy, 62.34%. Compared to the control group (other respiratory infections), the risk of disease was significantly increased for all diagnoses. 14 different neurological and psychiatric diagnoses were observed in the study. According to Dr. Volkmann, this resulted in an overall risk index of 1.27-1.36 for initial diagnoses and a risk index of 2.45-3.35 for initial diagnoses after intensive treatment.
Here, the physician built a bridge about 100 years into the past: The increased occurrence of neurological diseases in the context of post-COVID is reminiscent to a certain point of the increased occurrence of encephalitis lethargica following the three waves of the 'Spanish flu' from 1917 to 1920. Among long-term survivors, symptoms of very advanced Parkinson's were recognised decades later.
Dr. Volkmann explained that the figures of the current study, on the other hand, clearly indicate the need for long-term observation of post-COVID courses. Extrapolated to the current 32 million COVID-19 infections in Europe, this could mean up to 10 million neuro-COVID cases at worst. However, the lack of digital patient registers in the German context alone, poses a major problem for long-term monitoring in this and any other European country. In addition, Dr. Volkmann emphasises, neuropathological examinations of brain tissue are needed to clarify the mechanisms - but the lack of brain databases and autopsy culture (at least in Germany) pose a void, and a problem. In order to specifically counteract a post-COVID pandemic, the physician sees an urgent need for basic research on neuro-COVID and neurodegeneration research.
Prof. Dr. Susanne Schneider from the LMU, and scientific advisor to the YUVEDO Foundation spoke about "First studies on neuro-disorder & COVID-19". And the professor agreed with the overarching picture at stake: "The German health system should urgently prepare for increasing cases of post-COVID syndrome". In England, for example, which is several weeks ahead of Germany in terms of the incidence of infection, there is an increasing rush for long-COVID outpatient clinics.
While it was initially assumed that COVID-19 was "only" a respiratory infection, it is now known that the infection can lead to secondary diseases that affect a wide variety of organs. According to Prof. Schneider, a broad spectrum of long-term consequences can also be identified with regard to neurological clinical pictures - from headaches and drowsiness to smell and taste disorders to cerebrovascular diseases, or, for example, the Guillian-Barre syndrome.
Current studies also show: After severe initial disease, deterioration in cognitive functions can be seen in COVID-19 survivors. Here, Prof. Schneider cites a study by Hampshire et al.3 which highlights that compared to healthy test subjects, brain ageing of up to 10 years was evident in this study cohort. However, according to the LMU professor, further study results indicate that clinical or subclinical neurological changes can also occur after mild or asymptomatic COVID-19 courses. The physician also described the process by which more cases of dementia and Parkinson's disease could occur in the course of post-COVID. Via "hit and run", i.e. at a time when the COVID-19 infection can no longer be detected, a chronic low-grade inflammation process could occur, leading to further inflammation in the brain and thus contributing to neurodegeneration.
Special attention should be paid to this development. It is expected that the number of neurodegenerative diseases will double or even triple by 2050 - however, these are pre-COVID estimates, added Dr. Schneider. Neuro-COVID could make the disease curve even steeper. So what measures should be taken? First of all, it is important to clearly define what post-COVID symptoms are, the physician emphasises. It is important to understand the underlying pathomechanisms, identify risk factors, and explore treatment options. To this end, it is particularly important to establish long-COVID outpatient clinics and to increase professional exchange on the issue for engaging with the relevant databases. It is also crucial to prevent new cases through widespread vaccination.
References:
1. 2nd Yuvedo Online Conference: Neuro Diseases and COVID-19; 10 June 2021, 2 - 4.30 p.m.
2. Harrison et al. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry. DOI: https://doi.org/10.1016/S2215-0366(21)00084-5
3. Adam Hampshire, William Trender, Samuel R Chamberlain, Amy Jolly, Jon E. Grant, Fiona Patrick, Ndaba Mazibuko, Steve Williams, Joseph M Barnby, Peter Hellyer, Mitul A Mehta. Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study. medRxiv Pre Print Server. DOI: https://doi.org/10.1101/2020.10.20.20215863