Merve Atik1, Scott Przybelski1, Burcu Zeydan1, Orhun Kantarci1, June C. Kendall-Thomas1, Matthew Senjem1, Ana I. silva2, James Joers2, Katherine Gundry2, Alfredo Lorente2, Jeromy Thotland2, Dinesh K. Deelchand2, Young Woo Park3, Xiufeng Li2, Georgios Manousakis2, Abby Metzler2, Christophe Lenglet2, Lynn Eberly2, Meher R. Juttukonda4, David Salat4, Janet C Sherman4, Lauren Pollak4, George Harrold5, Shibani Mukerji4, Sevil Yasar6, Mehreen Nabi6, Sana Rehman6, Christof Karmonik7, Syed Gillani8, Valerie Flores8, Rachel G Davis8, Tetsuo Ashizawa9, Peter Barker10, Eva-M. Ratai4, Gulin Oz2, Kejal Kantarci1
1Mayo Clinic, 2University of Minnesota, 3Uniformed Services University of the Health Sciences, 4Massachusetts General Hospital, 5Brigham and Women's Hospital, 6Johns Hopkins University, 7The Methodist Hospital Neurological Institute, 8Houston Methodist Hospital, 9Methodist Hospital Research Institute, 10Johns Hopkins University S/M
Objective:
To investigate brain white matter hyperintensities (WMH) as a potential indicator of microvascular disease associated with long‐COVID.
Background:
Approximately 10% of patients with acute SARS‐CoV‐2 infection present with persistent symptoms recognized as long‐COVID. Neurological and cognitive symptoms are prevalent in patients with long‐COVID (PwLC), requiring a deeper understanding of the biological basis for potential therapeutic interventions. Cerebrovascular complications are observed during acute infection, underscoring the importance of understanding cerebrovascular outcomes.
Design/Methods:
Hospitalized PwLC (n= 24), non‐hospitalized PwLC (n = 76 during the acute infection) and controls (n = 75) who did not have a reported symptomatic Covid infection were recruited from the community at five US sites. PwLC were included if they developed neurological or cognitive sequelae within 6 months of confirmed infection and had at least one ongoing neurological symptom. Clinical evaluation and MRI were performed an average of 20±10 months after the acute infection. WMH volumes were measured from 3D T2‐weighted FLAIR MRIs using a semi‐automated approach for WMH segmentation. A linear regression model predicting log transformed WMH volume was used to investigate the association of age, groups, and the interaction of these two predictors along with an adjustment for total intracranial volume and site.
Results:
Compared to controls,
hospitalized PwLC, had a higher WMH volume relative to total intracranial volume associated with older age (intercept estimate = -1.906, p = 0.006). There were no group level difference between non-hospitalized PwLC and controls.
Conclusions:
Our observation suggests that hospitalization during acute COVID in older adults is associated with an increased risk in microvascular injury in the white matter and are more susceptible to cerebrovascular adverse outcomes than controls or those who do not require hospitalization. Impact of such microvascular changes on cognitive outcomes and persistence of long‐COVID symptoms is yet to be studied.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.