Neurological outcome and quality of life three months after COVID-19: a prospective observational cohort study.

BACKGROUND: To assess neurological manifestations and quality of life (QoL) three months after COVID-19. METHODS: In this prospective, multicentre, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin-Sticks-test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist-5) three months after disease onset. RESULTS: Of 135 consecutive COVID-19 patients, 31 (23%) required ICU-care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient-care (mild) during acute disease. At three-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included poly-neuro/myopathy (n=16, 12%), mild encephalopathy (n=2, 2%), parkinsonism (n=1, 1%), orthostatic hypotension (n=1, 1%), Guillain-Barre-Syndrome (n=1, 1%) and ischemic stroke (n=1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at three-month follow-up. Self-reported hyposmia/anosmia was lower (17%), however, improved compared to the acute disease (44%; P<0.001). In ICU patients, encephalopathy improved over time (from 29% during acute disease to 3% at follow-up, P=0.008). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety and post-traumatic stress disorders in 11%, 25%, and 11%, respectively. CONCLUSIONS: Despite recovery from acute infection, neurological symptoms were prevalent at three-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.