COVID-19 Prevalence and Cognitive Deficits in Neurological Patients
COVID-19 Prevalence and Cognitive Deficits in Neurological Patients
The purpose is to investigate the COVID-19 prevalence, associated morbidity and long-term
 cognitive deficits in consecutive patients presenting with acute neurological symptoms
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading in nearly every
 country in the world. Patients with coronavirus disease 2019 (COVID-19) typically present
 with cough, fever and respiratory illness. In another coronavirus (SARS-COV-1) causing the
 SARS outbreak in 2002 to 2003, neurons have been found to be highly susceptible for infection
 and the virus can cause extensive neuronal damage with only minimal respiratory affection.
 Similar to SARS-CoV-1, COVID-19 virus exploits the angiotensin-converting enzyme 2 (ACE-2)
 receptor to gain entry and infect cells. Both glial and neurons express ACE-2 receptors and
 makes them potential targets, however the neurotropic potential in humans remain largely
 undescribed. Neurological manifestations of COVID-19 have only been sporadically described in
 single or short series of case reports together with a case of COVID-19 RNA in the
 cerebrospinal fluid.

 Loss of smell (anosmia) may be a presenting symptom in COVID-19. Interestingly, in a study
 from Italy anosmia was present in 19,4% and not typical accompanied by nasal obstruction,
 rhinitis or sinusitis, making direct damage and invasion of the olfactory nerve more likely.
 A Chinese study have found that 36.6% of COVID-19 patients experience neurological symptoms
 and that severely affected COVID-19 patients reported more neurological symptoms.

 In general, neurological manifestations to viral disease may occur as a direct result of
 viral invasion and damage to either the central or peripheral nervous system or from an
 immune mediated neurological damage either during (para) or after (post) the viral infection.
 Furthermore, the inflammation in itself can increase the risk of arterial thrombosis and thus
 ischemic stroke.

 Early reports from Italy stresses the need to pay attention to neurological symptoms, as they
 are often neglected due to the systemic and respiratory impairment. Further, concerning
 reports from the Center for Disease Control (CDC) in USA, have estimated that out of
 COVID-19pos patients up to 46.5% may be asymptomatic/pre-symptomatic and 17,5% never develop
 classical COVID-19 symptoms. The COVID-19 infection is likely to be missed if patients
 present with symptoms from another organ system. Moreover, it poses a transmission risk for
 other admitted patients and healthcare workers and a risk that a possible association between
 e.g. neurological symptoms/diseases and a COVID-19 infection are missed. The role and
 presence of COVID-19 infection in patients presenting with acute neurological symptoms is
 currently unknown.
Eligibility criteria for the extended study:

 Inclusion Criteria:

 -  Adult patients

 -  New onset of neurological symptoms

 -  Independent in daily activities (modified Rankin Scale ≤ 2)

 -  Stroke or epilepsy/seizure

 Exclusion Criteria:

 -  Pre-existing neurodegenerative disease

 -  Diagnosed with cerebral neoplasm

 -  Pre-existing expected life expectancy < 3 months

 -  Suspected non-organic (functional) disorder