UK-Wide Surveillance of Neurological and Neuropsychiatric Complications of COVID-19: The First 153 Patients
Open accessAbstract
Background: Increasingly neurological complications of COVID-19 are identified, mostly in small series. Larger studies have been limited by both geography and specialty. Consequently, the breadth of complications is not represented. Comprehensive characterization of clinical syndromes is critical to rationally select and evaluate potential therapies. Methods: During the exponential pandemic phase, we developed coordinated online portals for rapid notification across the spectrum of major UK neuroscience bodies, representing neurology, stroke, psychiatry, and intensive care. Evidence of infection and clinical case definitions were applied prospectively. Cases were compared to overall Government Public Health COVID-19 reporting. Findings: Within three weeks, 153 cases were notified, both geographically and temporally representative of overall COVID-19 Public Health reports. Median (range) age was 71 (23-94) years. 77 (62%) had a cerebrovascular event: 57 (74%) ischemic strokes, nine (12%) intracerebral hemorrhages, and one CNS vasculitis. The second most common group were 39 (31%) who had altered mental status, including 16 (41%) with encephalopathy of whom seven (44%) had encephalitis. The remaining 23 (59%) had a psychiatric diagnosis of whom 21 (92%) were new diagnoses; including ten (43%) with psychosis, six (26%) neurocognitive (dementia-like) syndrome, and 4 (17%) an affective disorder. Cerebrovascular events predominated in older patients. Conversely, altered mental status, whilst present in all ages, had disproportionate representation in the young. Interpretation: This is the first nationwide, cross-specialty surveillance study of acute complications of COVID-19 in the nervous system. Alteration in mental status was common, reflecting encephalopathy/encephalitis and primary psychiatric diagnoses, often in young patients. These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatry.
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In both studies on older adults without dementia with acute COVID-19, assessment of neuropsychiatric symptoms was based on a clinician's judgment, and no use of standardised tools was reported.
“In both studies, assessment of neuropsychiatric symptoms was based on a clinician's judgment, and no use of standardised tools was reported.”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [14]
In that multi-centre study, 59% of patients with altered mental status met criteria for psychiatric diagnoses, with the great majority being new cases of psychoses, neurocognitive disorders, and affective disorders.
“As many as 59% of these patients met criteria for psychiatric diagnoses, with the great majority being new cases of psychoses, neurocognitive disorders, and affective disorders.”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [14]
In a multi-centre study including 125 patients with COVID-19 and complete clinical assessment, 31.2% presented with altered mental status at onset.
“A multi-centre study including 125 patients (most of whom aged 60 or above) with COVID-19 and a complete clinical assessment, found that, at onset, 31.2% presented with, among other symptoms, altered mental status”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [14]
A substantial proportion of COVID-19-infected patients experienced mental health problems sufficiently severe to meet criteria for a variety of new psychiatric diagnoses.
“A substantial proportion of infected patients also experienced mental health problems sufficiently severe to meet criteria for a variety of new psychiatric diagnoses, as well as neurocognitive syndromes, these latter potentially unveiling ongoing latent neurodegenerative processes (14).”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [14]
COVID-19-infected patients experienced neurocognitive syndromes that potentially unveil ongoing latent neurodegenerative processes.
“A substantial proportion of infected patients also experienced mental health problems sufficiently severe to meet criteria for a variety of new psychiatric diagnoses, as well as neurocognitive syndromes, these latter potentially unveiling ongoing latent neurodegenerative processes (14).”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [14]
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“…and central nervous systems (Baig and Sanders, 2020; Bullen et al., 2020; Butowt and Bilinska, 2020; Ellul et al., 2020; Iadecola et al., 2020; Li et al., 2020a; Li et al., 2020c; Natoli et al., 2020; Paniz-Mondolfi et al., 2020; Varatharaj et al., 2020; Zhou et al., 2020a; Zubair et al., 2020).”
BackgroundCOVID-19 and neuropsychiatric disorders: Common links and extended networks
Azizur, R., & Umme, H. (2021) · Journal of Neurology Neurological Science and Disorders · doi:10.17352/jnnsd.000044 · Cited by 6 · see citing works
Palermo, S. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.99414 · Cited by 6 · see citing works
Cappelletti, G., Brambilla, L., Strizzi, S., Limanaqi, F., Melzi, V., Rizzuti, M., Nizzardo, M., Saulle, I., Trabattoni, D., Corti, S. P., et al. (2025) · The FASEB Journal · doi:10.1096/fj.202401604rrr · Cited by 5 · see citing works
The outcome of COVID‐19 patients in the intensive care unit in Sudan: A cross‐sectional study
ali, M. A., Abdalrahman, N. A., Shanab, E. A. I., Mohammed, M. M. A., Ibrahim, M. M., & Abdalrahman, I. B. (2023) · Health Science Reports · doi:10.1002/hsr2.1161 · Cited by 5 · see citing works
“In this cohort, only 8% of patients developed neurological complications, this percentage is much lower when compared to the study conducted in the United Kingdom where 62% of participants developed neurological events both at presentation and during the hospital stay.(25) Moreover, a global cohort study of the incide…”
ResultCorrelation between CSF biomarkers and COVID-19 meningoencephalitis: A case series
Moghimi, M., Moghtader, A., Jozpanahi, M., et al. (2020) · Respiratory Medicine Case Reports · doi:10.1016/j.rmcr.2020.101335 · Cited by 5 · see citing works
“In one national registry of 125 patients with COVID-19 and neurological or psychiatric disease reported over a 3-week period, 31% patients had altered mental status, which included 13% with encephalopathy (of whom 6% had encephalitis) [1].”
Pharmacotherapy of Mental Disorders Associated with COVID-19
Khaustova, O. O., & Чабан, О. (2021) · Психиатрия психотерапия и клиническая психология · doi:10.34883/pi.2021.12.1.008 · Cited by 5 · see citing works
Day, C., Studders, C., Arklie, K., Kaur, A., Teetzen, K., Kirsch, R. L., Abelseth, L., Fraser, I. S., Abelseth, E., & Willerth, S. M. (2021) · Reviews in the Neurosciences · doi:10.1515/revneuro-2021-0041 · Cited by 4 · see citing works
Priori, A., Bai, F., Rovito, R., Marchetti, G. C., Monforte, A. D., Papa, G. F. S., Pellegrino, G. M., Centanni, S., Chiumello, D., Bonifazi, M., et al. (2021) · doi:10.54103/milanoup.57 · Cited by 4 · see citing works
Post-COVID-19 Respiratory Management: Expert Panel Report
Guleria, R., Solanki, R. N., Mohan, A., et al. (2022) · The Indian Journal of Chest Diseases and Allied Sciences · doi:10.5005/ijcdas-62-4-179 · Cited by 4 · see citing works
Gasión, V., Barceló‐Soler, A., Beltrán-Ruiz, M., Hijar-Aguinaga, R., Camarero-Grados, L., del Hoyo, Y. L., García‐Campayo, J., & Montero‐Marín, J. (2023) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-023-04240-0 · Cited by 5 · see citing works
Standing on the shoulders of giants: 100 years of neurology and epidemic infections
Tooren, H. V. D., Ellul, M. A., Davies, N. W. S., Easton, A., Vincent, A. C., Solomon, T., & Michael, B. D. (2020) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-324366 · Cited by 4 · see citing works
Self-citationWalton, D., Thakur, K. T., Venkatesan, A., Breen, G. D., Solomon, T., & Michael, B. D. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.637586 · Cited by 4 · see citing works
Self-citationThe Impact of the COVID-19 Pandemic on the Health of People with Mental Disorders
Enikolopov, S. N., Boyko, O. M., Medvedeva, T. I., Vorontsova, O. Y., Баранов, П. А., & Oleichik, I. V. (2023) · Psikhiatriya · doi:10.30629/2618-6667-2023-21-2-72-88 · Cited by 5 · see citing works
COVID-19 Hastalarında Yoğun Bakım Yaklaşımı
Ayoğlu, H. (2020) · Turkish Journal of Diabetes and Obesity · doi:10.25048/tudod.767999 · Cited by 4 · see citing works
Chen, C., Chiang, P.-C., & Chen, T. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2020.613552 · Cited by 4 · see citing works
Rai, P., Shivaprasad, A., Tremont‐Lukats, I. W., & Tummala, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-67123-5_16 · Cited by 4 · see citing works
Neurological, Psychological, and Cognitive Manifestations of Long-COVID
Cascella, M., & Blasio, E. D. (2021) · Springer eBooks · doi:10.1007/978-3-030-86705-8_4 · Cited by 4 · see citing works
A Fatal Case of Acute Disseminated Encephalomyelitis: A Diagnosis to Ponder in Pandemic
Gupta, P., Sabharwal, P., Kumar, A., et al. (2022) · Indian Journal of Critical Care Medicine · doi:10.5005/jp-journals-10071-24185 · Cited by 4 · see citing works
Sleep disorders in doctors in the context of the COVID-19 pandemic
Korabelnikova, E. A., Воробьева, О. В., Makarov, S. A., & Danilov, A. B. (2021) · Medical alphabet · doi:10.33667/2078-5631-2021-3-48-56 · Cited by 3 · see citing works
Performance of Existing and Novel Surveillance Case Definitions for COVID-19 in the CommunityPreprint
Reses, H. E., Fajans, M., Lee, S., et al. (2020) · medRxiv · doi:10.1101/2020.10.02.20195479 · Cited by 3 · see citing works
COVID-19-Associated Schizophrenia-Like Psychosis
Bravve, L. V., & Zakharova, N. V. (2023) · Psikhiatriya · doi:10.30629/2618-6667-2022-20-4-44-53 · Cited by 2 · see citing works
Lacko, J., & Ružický, E. (2023) · Springer proceedings in business and economics · doi:10.1007/978-3-031-25390-4_20 · Cited by 2 · see citing works
Klocheva, E. G., Голдобин, В. В., & Зафаровна, О. Ф. (2023) · Neurology neuropsychiatry Psychosomatics · doi:10.14412/2074-2711-2023-2-34-40 · Cited by 2 · see citing works
Neurological manifestations in hospitalized COVID-19 patients: a cross-sectional study
Kashipazha, D., Shalilahmadi, D., Shamsaei, G., & Porkar, N. F. (2024) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-024-00818-8 · Cited by 2 · see citing works
“Stroke was reported at 1.7% in Spain [14], 3.5% to 5.7% in China [5], and 62% in a report from the UK [18].”
BackgroundInfluentialNeurological and psychological aspects of COVID-19 infection (literature review)
Bulgakova, S. V., Захарова, Н. О., Treneva, E. V., & Николаева, А. В. (2021) · Medsestra (Nurse) · doi:10.33920/med-05-2103-05 · Cited by 2 · see citing works
Neuropsychiatric complications from COVID-19
Solano, J. G. G., & Bernita, R. E. S. (2022) · Salud Ciencia y Tecnología · doi:10.56294/saludcyt2022223 · Cited by 2 · see citing works
- Authors
- Varatharaj, A., Thomas, N., Ellul, M., Davies, N. W., Pollak, T., Tenorio, E. L., Sultan, M., Easton, A., Breen, G., Zandi, M., Coles, J. P., Manji, H., Al-Shahi Salman, R., Menon, D., Nicholson, T., Benjamin, L., Carson, A., Smith, C., Turner, M. R., Solomon, T., Kneen, R., Pett, S., Galea, I., Thomas, R. H., & Michael, B.
- Affiliations
- University of Southampton (GB)
- Newcastle University (GB)
- University of Liverpool (GB)
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- University of Utah (US)
- King's College London (GB)
- University College London (GB)
- University of Cambridge (GB)
- University of Edinburgh (GB)
- University of Manchester (GB)
- University of Oxford (GB)
- Alder Hey Children's NHS Foundation Trust (GB)
- MRC Clinical Trials Unit at UCL (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- Corresponding author
- Michael, Benedict
- ORCID
- Varatharaj, Aravinthan
- Thomas, Naomi
- Ellul, Mark
- Davies, Nicholas WS
- Pollak, Tom
- Sultan, Mustafa
- Easton, Ava
- Breen, Gerome
- Zandi, Michael
- Coles, Jonathan P
- Manji, Hadi
- Menon, David
- Nicholson, Timothy
- Benjamin, Laura
- Carson, Alan
- Smith, Craig
- Turner, Martin R
- Solomon, Tom
- Kneen, Rachel
- Pett, Sarah
- Galea, Ian
- Thomas, Rhys H.
- Michael, Benedict
- Venue
- SSRN Electronic Journal
- Publisher
- Elsevier BV
- Published
- 2020
- ISSN
- 1556-5068 (ISSN-L)
- OpenAlex
- W3024699465
- Cited by
- 160
- References
- 0
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 24 · 2022: 26 · 2021: 59 · 2020: 38
- Type
- posted content
- Language
- en
- Open access
- green
- doi.org
- Locations
- SSRN Electronic Journal (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, neurological complications, neuropsychiatric complications, cerebrovascular events, ischemic stroke, intracerebral hemorrhage, encephalopathy, encephalitis, altered mental status, psychosis, mood disorders, case surveillance, case definition, young patients
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