COVID-19 in patients with neurological disorders

Objective: Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) posed an unprecedented challenge to healthcare communities worldwide. While emerging evidence suggests several neurological complications from COVID-19, it remains unclear if patients with neurological disorders are more vulnerable to COVID-19 Background: Center for Disease Control and Prevention suggested that dementia is possibly a risk factor for COVID-19, and we noted higher hospitalization and mortality from COVID-19 in patients with dementia/neurodegenerative disorders. Design/Methods: A matched control cohort, without a known neurological disorder, who were diagnosed with COVID-19 after January 20th, 2020, was used for comparisons. One-to-one propensity score matching was done for baseline characteristics and other comorbid conditions. 16,301/6,709,355 (0.24%) patients with neurological disorders developed COVID-19. After 1:1 propensity matching, 13,166 patients were included each in the study and the control cohort. Results: Among the subgroups, patients with previous strokes had higher ICU admission rate, patients with neuromuscular and sleep disorders had higher risk of intubation, and patients with neurodegenerative disorders (dementia) had higher risk of mortality. Clinical outcomes of COVID-19 in patients with headaches, multiple sclerosis, and movement disorders were similar to matching controls. Clinical outcome of COVID-19 varied between different neurological disorders. Patients with neuromuscular disorders can have respiratory symptoms, and about 45% of patients with sleep disorders have obstructive sleep apnea, and they were more likely to be intubated, which is consistent with previous reports. Living in nursing homes, inability to properly adhere to healthcare policies, and advanced directives with do not resuscitate order may have led to increased death in this cohort Conclusions: In this study, we could not assess the disease severity of COVID-19, and results are based on reported data. Despite limitations, this study showed that patients with some neurological conditions, particularly dementia, are possibly more vulnerable to COVID-19.