Annals of neurologyMar 26, 2023

Long COVID’s Neurologic Symptoms Vary with How Severe the Initial COVID-19 Was

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Updated Apr 6, 2026

Abstract

Patients with post-hospitalization Neuro-PASC reported neurologic symptoms such as 'brain fog' (81.2%) and fatigue (85.8%) on average 6.8 months after onset.

Post-hospitalization Neuro-PASC patients were significantly older than non-hospitalized patients (mean 53.9 vs 44.9 years).
A higher proportion of post-hospitalization patients had pre-existing health conditions compared to non-hospitalized patients.
Post-hospitalization patients exhibited more abnormal neurologic examinations (62.2%) than non-hospitalized patients (37%).
Cognitive testing revealed that post-hospitalization patients performed worse in processing speed, attention, and working memory tasks.
Quality of life was impaired in both groups across cognitive, fatigue, sleep, anxiety, and depression domains.
Subjective cognitive ability correlated with objective test results in non-hospitalized patients, but not in post-hospitalization patients.

Simplified

OBJECTIVE: To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients.

METHODS: Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021.

RESULTS: PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients.

INTERPRETATION: PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.

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Potential Conflicts of Interest. The authors do not have conflicts of interest.

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Long COVID’s Neurologic Symptoms Vary with How Severe the Initial COVID-19 Was

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