Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews

Abhilasha P Boruah; Kiran T Thakur; Sachin P Gadani; Kavita U Kothari; Mashina Chomba; Alla Guekht; Kimia Heydari; Fan Kee Hoo; Soonmyung Hwang; Benedict D Michael; Maya V Pandit; Carlos A Pardo; Kameshwar Prasad; Zomer Sardar; Katrin Seeher; Tom Solomon; Andrea S Winkler; Greta K Wood; Nicoline Schiess

doi:10.1016/j.jns.2023.120858

Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews

J Neurol Sci. 2023 Dec 15:455:120858. doi: 10.1016/j.jns.2023.120858. Epub 2023 Oct 29.

Authors

Abhilasha P Boruah¹, Kiran T Thakur², Sachin P Gadani³, Kavita U Kothari⁴, Mashina Chomba⁵, Alla Guekht⁶, Kimia Heydari⁷, Fan Kee Hoo⁸, Soonmyung Hwang⁹, Benedict D Michael¹⁰, Maya V Pandit¹¹, Carlos A Pardo³, Kameshwar Prasad¹², Zomer Sardar¹³, Katrin Seeher¹⁴, Tom Solomon¹⁵, Andrea S Winkler¹⁶, Greta K Wood¹⁷, Nicoline Schiess¹⁸

Affiliations

¹ Case Western Reserve University School of Medicine, OH, USA.
² Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, USA.
³ Johns Hopkins Department of Neurology, Baltimore, USA.
⁴ Consultant to Library & Digital Information Networks, World Health Organization, Geneva, Switzerland.
⁵ University of Zambia, Lusaka, Zambia.
⁶ Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian Medical Research University, Moscow, Russia.
⁷ Columbia University, New York, USA.
⁸ Faculty of Medicine and Health Sciences, University Putra Malaysia, Kuala Lumpur, Malaysia.
⁹ Icahn School of Medicine at Mount Sinai, New York, USA.
¹⁰ Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Neurology, Walton Centre NHS Foundation Trust, NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK.
¹¹ New York Medical College, Valhalla, USA.
¹² Department of Neurology Fortis Flt Lt, Rajan Dhall Hospital, Vasant Kunj, New Delhi, India.
¹³ Columbia University Irving Medical Center, New York, NY, USA.
¹⁴ Brain Health Unit, World Health Organization, Geneva, Switzerland.
¹⁵ The Pandemic Institute, The Spine, Liverpool L7 3FA, UK; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, UK; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK.
¹⁶ Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹⁷ Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK.
¹⁸ Brain Health Unit, World Health Organization, Geneva, Switzerland. Electronic address: schiessn@who.int.

Abstract

Background: Pre-existing neurological diseases have been identified as risk factors for severe COVID-19 infection and death. There is a lack of comprehensive literature review assessing the relationship between pre-existing neurological conditions and COVID-19 outcomes. Identification of high risk groups is critical for optimal treatment and care.

Methods: A literature review was conducted for systematic reviews, meta-analyses, and scoping reviews published between January 1, 2020 and January 1, 2023. Literature assessing individuals with pre-existing neurological diseases and COVID-19 infection was included. Information regarding infection severity was extracted, and potential limitations were identified.

Results: Thirty-nine articles met inclusion criteria, with data assessing >3 million patients from 51 countries. 26/51 (50.9%) of countries analyzed were classified as high income, while the remaining represented middle-low income countries (25/51; 49.0%). A majority of evidence focused on the impact of cerebrovascular disease (17/39; 43.5%) and dementia (5/39; 12.8%) on COVID-19 severity and mortality. 92.3% of the articles (36/39) suggested a significant association between neurological conditions and increased risk of severe COVID-19 and mortality. Cerebrovascular disease, dementia, Parkinson's disease, and epilepsy were associated with increased COVID severity and mortality.

Conclusion: Pre-existing neurological diseases including cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, and Parkinson's disease are significant risk factors for severity of COVID-19 infection and mortality in the acute infectious period. Given that 61.5% (24/39) of the current evidence only includes data from 2020, further updated literature is crucial to identify the relationship between chronic neurological conditions and clinical characteristics of COVID-19 variants.

Keywords: COVID-19; Cerebrovascular disease; Dementia; Multiple sclerosis; Neurological conditions; SARS-CoV-2; parkinson's disease.

Publication types

Review

MeSH terms

COVID-19* / epidemiology
Cerebrovascular Disorders*
Coinfection*
Dementia*
Epilepsy* / complications
Epilepsy* / epidemiology
Humans
Parkinson Disease*
SARS-CoV-2
Systematic Reviews as Topic

Supplementary concepts

SARS-CoV-2 variants

Grants and funding

001/WHO_/World Health Organization/International