Brain MRI and Neuropsychological Findings at Long-term Follow-up After COVID-19 Hospitalisation: an Observational Cohort Study

Objectives: To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system.

Design: Ambidirectional observational cohort study.

Setting: All 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020.

Participants: A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI.

Main Outcome Measures: Findings on brain MRI, neurocognitive test results and reported fatigue.

Results: Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings.

Conclusions: In this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.