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Trajectories of Neurologic Recovery 12 Months After Hospitalization for COVID-19: A Prospective Longitudinal Study

Frontera, Jennifer A; Yang, Dixon; Medicherla, Chaitanya; Baskharoun, Samuel; Bauman, Kristie; Bell, Lena; Bhagat, Dhristie; Bondi, Steven; Chervinsky, Alexander; Dygert, Levi; Fuchs, Benjamin; Gratch, Daniel; Hasanaj, Lisena; Horng, Jennifer; Huang, Joshua; Jauregui, Ruben; Ji, Yuan; Kahn, D Ethan; Koch, Ethan; Lin, Jessica; Liu, Susan; Olivera, Anlys; Rosenthal, Jonathan; Snyder, Thomas; Stainman, Rebecca; Talmasov, Daniel; Thomas, Betsy; Valdes, Eduard; Zhou, Ting; Zhu, Yingrong; Lewis, Ariane; Lord, Aaron S; Melmed, Kara; Meropol, Sharon B; Thawani, Sujata; Troxel, Andrea B; Yaghi, Shadi; Balcer, Laura J; Wisniewski, Thomas; Galetta, Steven
BACKGROUND/OBJECTIVES/OBJECTIVE:Little is known about trajectories of recovery 12-months after hospitalization for severe COVID. METHODS:We conducted a prospective, longitudinal cohort study of patients with and without neurological complications during index hospitalization for COVID-19 from March 10, 2020-May 20, 2020. Phone follow-up batteries were performed at 6- and 12-months post-COVID symptom onset. The primary 12-month outcome was the modified Rankin Scale (mRS) comparing patients with or without neurological complications using multivariable ordinal analysis. Secondary outcomes included: activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA) and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Changes in outcome scores from 6 to 12-months were compared using non-parametric paired-samples sign test. RESULTS:Twelve-month follow-up was completed in N=242 patients (median age 65, 64% male, 34% intubated during hospitalization) and N=174 completed both 6- and 12-month follow-up. At 12-months 197/227 (87%) had ≥1 abnormal metric: mRS>0 (75%), Barthel<100 (64%), t-MoCA≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%) and poor sleep (10%). 12-month mRS scores did not differ significantly among those with (N=113) or without (N=129) neurological complications during hospitalization after adjusting for age, sex, race, pre-COVID mRS and intubation status (adjusted OR 1.4, 95% CI0.8-2.5), though those with neurological complications had higher fatigue scores (T-score 47 vs 44, P=0.037). Significant improvements in outcome trajectories from 6- to 12-months were observed in t-MoCA scores (56% improved, median difference 1 point, P=0.002), and Neuro-QoL anxiety scores (45% improved, P=0.003). Non-significant improvements occurred in fatigue, sleep and depression scores in 48%, 48% and 38% of patients, respectively. Barthel and mRS scores remained unchanged between 6 and 12-months in >50% of patients. DISCUSSION/CONCLUSIONS:At 12-months post-hospitalization for severe COVID, 87% of patients had ongoing abnormalities in functional, cognitive or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a prior history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurological complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6- to 12-months. These results may not be generalizable to those with mild/moderate COVID.
PMID: 35314503
ISSN: 1526-632x
CID: 5192402

Keeping the team together: Transformation of an inpatient neurology service at an urban, multi-ethnic, safety net hospital in New York City during COVID-19

Lord, Aaron S; Lombardi, Nicole; Evans, Katherine; Deveaux, Dewi; Douglas, Elizabeth; Mansfield, Laura; Zakin, Elina; Jakubowska-Sadowska, Katarzyna; Grayson, Kammi; Omari, Mirza; Yaghi, Shadi; Humbert, Kelley; Sanger, Matt; Kim, Sun; Boffa, Michael; Szuchumacher, Mariana; Jongeling, Amy; Vazquez, Blanca; Berberi, Nisida; Kwon, Patrick; Locascio, Gianna; Chervinsky, Alexander; Frontera, Jennifer; Zhou, Ting; Kahn, D Ethan; Abou-Fayssal, Nada
The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.
PMCID:7430288
PMID: 32877768
ISSN: 1872-6968
CID: 4583362

Russian vs English speakers: Symptom validity in forensic neuropsychological assessment [Meeting Abstract]

Chervinsky, AB
ISI:000245781200014
ISSN: 1385-4046
CID: 2698612

Computerized neuropsychological assessment: A survey of professional attitudes [Meeting Abstract]

Chervinsky, AB; Hamsher, K
ISI:000237425800007
ISSN: 1385-4046
CID: 2698602

Neuropsychological assessment of non-english and non-native speakers of English [Meeting Abstract]

Artiola, L; Chervinsky, F; Chervinsky, A
ISI:000229555300020
ISSN: 1385-4046
CID: 2698712

Attention: Test Performance of Clinical and Forensic Groups, Intraindividual Variability [Meeting Abstract]

Chervinsky, AB
ORIGINAL:0012244
ISSN: 1469-7661
CID: 2698782

Level of Performance and Discrepancies on Picture Completion and Picture Arrangement Subtests of the WAIS-III Among Forensic and Clinical Cases [Meeting Abstract]

Chervinsky, AB
ORIGINAL:0012247
ISSN: 1385-4046
CID: 2698812

SPEED OF INFORMATION PROCESSING: PERFORMANCE OF CLINICAL GROUPS, INTRAINDIVIDUAL VARIABILITY [Meeting Abstract]

Chervinsky, AB
ORIGINAL:0012245
ISSN: 1469-7661
CID: 2698792

Efficacy of inpatient multidisciplinary Rehabilitation versus low intensity home management after Moderate-Severe Brain Injury. [Meeting Abstract]

Spector, J; Warden, DL; Salazar, AM; Schwab, K; Chervinsky, A; Braverman, S
ISI:000083479600344
ISSN: 0887-6177
CID: 2698732

Motivation for traumatic brain injury rehabilitation questionnaire (MOT-Q): reliability, factor analysis, and relationship to MMPI-2 variables

Chervinsky, A B; Ommaya, A K; deJonge, M; Spector, J; Schwab, K; Salazar, A M
A Likert scale questionnaire was developed to assess motivation for postacute rehabilitation by traumatic brain injury patients. Items were designed to reflect head-injured individuals' statements about their attitudes toward head injury rehabilitation. Factors such as denial of illness, anger, compliance with treatment, and medical information seeking behavior were used to assess unfavorable and favorable components of motivation. Reliability was assessed using Cronbach's Alpha, which was found to be 0.91 for the total scale. Four factor analysis derived subscales were identified: Lack of Denial, Interest in Rehabilitation, Lack of Anger, and Reliance on Professional Help. Correlation and multiple regression analyses demonstrated moderate relationships between MOT-Q and several MMPI-2 variables largely related to indicators of somatic distress, depression and capacity for self-sufficiency. Lack of Denial subscale showed the strongest relationship to MMPI-2 of all MOT-Q variables, while Interest in Rehabilitation showed the best correlation to the MOT-Q total.
PMID: 14590608
ISSN: 0887-6177
CID: 2698572