OBJECTIVES: Examine the long-term incident neurologic sequelae post COVID recovery and assess relationship with COVID severity using real-world data.

METHODS: This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were ≥18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and ≥12 months after index date, known demographics, not pregnant, and with no baseline neurologic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Neurologic sequelae examined were persistent headache, migraine, anosmia, sleep disturbance, cognitive dysfunction, post-traumatic stress disorder, suicidality, anxiety, depression, attention deficit hyperactivity disorder, cerebrovascular disease (CVD), fatigue/myalgia and tremors. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes.

RESULTS: Of 534,843 patients, 107,656 (Mild 96,637; Moderate 3,371; Severe 7,648) met the study inclusion criteria. Median follow up time was 750, 774 and 768 days in the mild, moderate and severe cohorts, respectively.

About 20% of patients in the mild, 32% in moderate and 35% in the severe cohort experienced ≥3 neurologic sequelae during the follow-up period. A significantly higher incidence of any neurologic sequelae was observed in moderate and severe cohorts compared with the mild cohort (IRR 3.1 and 3.0, respectively; p<0.001). Cognitive dysfunction (moderate IRR 5.4, severe IRR 5.7; p<0.001), and CVD (moderate IRR 4.8, severe IRR 4.0; p<0.001) were the most commonly occurring manifestations in moderate and severe cohorts compared with the mild cohort.

CONCLUSIONS: These results highlight the need for long-term monitoring and preventative strategies for neurologic conditions post COVID recovery that might impair quality of life and increase overall healthcare burden in the U.S.