Outcome of severe COVID-19: spotlight on fatigue, fatiguability, multidomain complaints and pattern of cognitive deficits in a case series without prior brain dysfunction and without COVID-19-related stroke and/or cardiac arrest

Outcome of severe COVID-19: spotlight on fatigue, fatiguability, multidomain complaints and pattern of cognitive deficits in a case series without prior brain dysfunction and without COVID-19-related stroke and/or cardiac arrest
Valérie Beaud1, Sonia Crottaz-Herbette1, Vincent Dunet2, Jean-François Knebel1, Pierre-Alexandre Bart3, Stephanie Clarke1
1 Service of Neuropsychology and Neurorehabilitation, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
2 Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
3 Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
ABSTRACT
Background: Cognitive deficits were often reported during the acute and post-acute stages of severe COVID-19 and were often, but not always, associated with signs of brain damage. Population-wide surveys highlighted the need for investigations into the nature, the severity and the evolution of cognitive, behavioural and psychiatric deficits.
Case presentation: We report the outcome at 12 months after severe COVID-19 involving intensive care unit stay and mechanical ventilation in six patients. None of the patients had history of prior brain dysfunction and none sustained stroke and/or cardiac arrest during COVID-19. A pervading mental and physical fatigue was consistently reported as well as numerous multidomain complaints, which affect to some extend everyday life, and for some of the patients a mental fatiguability, a certain degree of neurobehavioural (apathy) and/or psychiatric (anxiety) dysfunction. Standardized neuropsychological tests revealed for 4 of the 6 patients the occurrence relatively isolated of cognitive dysfunction or performance at the lower limit of the norm in some, but not all attentional, executive and/or working memory tests. Somatic scales highlighted the presence of dyspnoea, muscle weakness, olfactory disorder and/or minor sleep problems in some but not all patients.
Conclusion: Fatigue, fatiguability, multidomain complaints, which affect to some extend everyday life, cognitive dysfunction or performance at the lower limit of the norm and a certain degree of neurobehavioural and/or psychiatric and/or somatic dysfunction can occur in the aftermath of severe COVID-19 even in the absence of neurological antecedents or of COVID-19-related stroke and/or cardiac arrest.