Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity

Gina S. Perez Giraldo, Sareen T. Ali, Anthony K. Kang, Tulsi R. Patel, Shreya Budhiraja, Jordan I. Gaelen, Grace K. Lank, Jeffrey R. Clark, Shreya Mukherjee, Tracey Singer, Aditi Venkatesh, Zachary S. Orban, Patrick H. Lim, Millenia Jimenez, Janet Miller, Carolyn Taylor, April L. Szymanski, Jessica Scarpelli, Edith L. Graham, Roumen D. BalabanovBianca E. Barcelo, Joshua G. Cahan, Kaitlyn Ruckman, Alan G. Shepard, Marc W. Slutzky, Kathrin LaFaver, Priya U. Kumthekar, Neil K. Shetty, Katherine S. Carroll, Sam U. Ho, Rimas V. Lukas, Ayush Batra, Eric M. Liotta, Igor J. Koralnik*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. Methods: Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. Results: PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were “brain fog” (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. Interpretation: PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146–159.

Original languageEnglish (US)
Pages (from-to)146-159
Number of pages14
JournalAnnals of neurology
Issue number1
StatePublished - Jul 2023

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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