Covid-19 with Pre-Existing Neurological Disease

Abstract

Objective: COVID-19 has varying impact on different groups of people based on age, gender, race and comorbidities. Although the implications of COVID-19 on chronic pulmonary and cardiovascular disease have been extensively studied, the impact on neurological disease remains unclear. We attempt to identify the outcome and challenges of COVID-19 in patients with chronic neurological conditions.

Methods: We conducted a systematic review and meta-analysis of 15 studies and 11,011 patients to compare composite poor outcome and mortality between patients with and without neurological comorbidities. We also analyzed the different clinical presentations and outcome of COVID-19 in different neurological conditions.  

Results: We found a markedly higher incidence of composite poor outcome (Odds Ratio: 5.57, 95% CI: 3.81-8.12, P = 0.02) and a higher mortality (Odds Ratio: 6.47, 95% CI: 3.94 - 10.63, P = 0.008) among patients with pre-existing neurological disease, and no significantly different outcomes between patients with cerebrovascular disease and dementia. Linear Meta-regression analysis revealed that the impact of chronic neurological disease on COVID-19 was independent of chronic cardiovascular disease (P=0.406), hypertension (P=0.458), diabetes mellitus (P=0.512), COPD (P=0.281), and advanced age (p=0.066).

Conclusion: Patients with chronic neurological disease seem to develop moderate/severe COVID-19 more frequently, and have an increased mortality rate, independent of other comorbidities. They also show atypical clinical presentation in SARS-CoV-2 infection. Advanced age, cognitive dysfunction, immunosuppression, and respiratory muscle weakness might be responsible for the adverse COVID-19 outcomes in these patients.