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Study: Nearly one-third of Covid-19 patients show altered mental state
Some experts said that President Donald Trump, who was hospitalized with COVID at Walter Reed National Military Medical Center beginning Friday, is of the age and gender of the patients in the study who were more likely to develop altered mental function and therefore could be at higher risk for such symptoms. He also has a history of high cholesterol, one of the preexisting conditions that appear to increase risk. But the president's doctors have given no indication that he has had any neurological symptoms; the White House had released videos of him talking to the public about how well he was doing. Trump returned to the White House on Monday evening.
Koralnik urged caution in drawing inferences from the study to Trump's condition. "I think we should be careful trying to ascribe a risk to an individual, based on this retrospective study," he said. "We need to know more about that individual's health records, which are not public." Altered mental function was not the only neurological complication the Northwestern study found. Overall, 82% of the hospitalized patients had neurological symptoms at some point in the course of the disease from symptom onset through hospitalization, the study found. That is a higher rate than what has been reported in studies from China and Spain, but the researchers say that may be because of genetic factors or that the Northwestern hospitals may have had more time to identify neurological issues because they were not as overwhelmed with patients as the other hospitals.
"This is an important study, since the neurological complications of the infection seem to be frequent and in many cases long-lasting, but yet have not received much attention," said Dr. Avindra Nath, chief of the section on infections of the nervous system at the National Institute of Neurological Disorders and Stroke, who was not involved in the study. Among the neurological symptoms, muscle pain occurred in about 45% of patients and headaches in about 38%. About 30% had dizziness. Smaller percentages had disorders of taste or smell.
Younger patients were more likely to develop neurological symptoms overall, except for encephalopathy, which was more common in older people, the study said. The researchers speculated that the younger people might have been more likely to seek hospital care for symptoms like muscle pain, headache or disease, or that doctors paid more attention to those symptoms in younger people because they were less worried about their risk of respiratory failure. About a quarter of the patients had severe enough respiratory problems to require ventilators, while the rest were considered moderately ill and were treated either in intensive care or in a COVID ward.
The study found that Black and Latino patients were not more likely than other groups to develop neurological symptoms. It found that patients at Northwestern Memorial Hospital, an academic medical center in Chicago that is the health system's flagship hospital, were younger, more often Black residents and had more preexisting medical conditions than patients in the suburban hospitals in the network. The patients at Northwestern Memorial were more likely to have overall neurological symptoms but were not more likely to have encephalopathy. They also had lower mortality rates and were functioning better when they were discharged, even though patients at the non-academic suburban hospitals weren't more likely to be sick enough to need ventilators. That suggests patients may have received more specialized care or better resources at the academic hospital, the study said.
"It is also interesting but concerning that they found differences in the outcome of patients between the various hospitals, which they attribute to differences in the quality of care provided," Nath said. "This means that the hospitalized patients require a high level of care, which is not readily available in most places."
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