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Stress can exacerbate symptoms of long-term COVID: Study

by Pragati Singh

According to a new study, the death of a loved one, financial or food insecurity, or the emergence of a new impairment are some of the strongest predictors of whether a patient hospitalised for COVID-19 would experience extended COVID symptoms a year later.

The study, led by researchers from NYU Grossman School of Medicine, discovered that adult patients with such “major life stressors” (present in more than 50% of those followed) were at least twice as likely to suffer from depression, brain fog, fatigue, sleep problems, and other long-term COVID-19 symptoms, according to the study authors.

The study, which was published online this week in the Journal of the Neurological Sciences (JNS), also confirmed the contribution of traditional factors to increased long-term COVID risk that had previously been demonstrated in previous studies: older age, a higher disability level to begin with, and a more severe initial case of COVID-19.
“Our study is unique in that it investigates the impact of life stressors as predictors of long-term cognitive and functional disabilities that affected quality of life in a large population,” says lead study author Jennifer A. Frontera, MD, professor in the Department of Neurology at NYU Langone Health.

“Therapies that reduce the trauma of the most stressful life events must be a fundamental aspect of long-term COVID treatment, with further research needed to verify the optimal treatments.”
The modified Rankin Scale (mRS), the Barthel Index, the Montreal Cognitive Assessment (t-MoCA), and the NIH/PROMIS Neurological Quality Of Life (NeuroQoL) batteries were used in the study to assess daily function, clear thinking (cognition), anxiety, depression, tiredness, and sleep quality. Between March 10, 2020 and May 20, 2020, the team sought to contact each of 790 patients six months and a year following their COVID-19 hospitalisation at NYU Langone Health.

451 (57%) of these surviving patients completed 6-month and/or 12-month follow-up, with 17% dying between discharge and 12-month follow-up and 51% reporting major life stresses.
Life stresses such as financial hardship, food insecurity, the loss of a close contact, and new disability were the biggest independent predictors of extended COVID-19 symptoms in studies that examined variables for their contribution to poor outcomes. These same stresses also predicted poorer functional status, depression, exhaustion, sleep scores, and decreased capacity to participate in everyday activities such as eating, dressing, and bathing.

Gender was also a factor, as previous research has revealed that women are more prone to autoimmune illnesses, which might have an influence on results.

Furthermore, pandemic-related pressures may have revealed previously undiscovered mental problems.
Neurological Long COVID May Involve Multiple Conditions
A second research done by Frontera and colleagues, which was published online on September 29, 2022, in PLOS ONE, discovered that people with long COVID neurological disorders may be classified into three symptom categories.
Because there is no existing biological definition for extended COVID, many research group different symptoms into what is presently a blanket diagnosis, without considering clinical significance, according to Frontera. As a result of the inherent ambiguity, “it is difficult to judge treatment techniques.”

The research team gathered data on symptoms, therapies received, and results for 12 months following hospitalisation with COVID-19 for the PLOS One study, with treatment success assessed again using conventional metrics (modified Rankin Scale, Barthel Index, NIH NeuroQoL). The three new disease groupings were as follows:
Cluster 1: Limited symptoms (mostly headaches) and few treatment approaches
Cluster 2: Patients with a variety of symptoms, including anxiety and depression, who underwent a variety of therapies, ranging from antidepressants to psychological counselling.
Cluster 3 is mostly characterised by respiratory symptoms such as shortness of breath. Many patients also complained of headaches and cognitive issues, and the majority of them got physical therapy.
Patients with the most severe symptoms (symptom Cluster 2) had greater rates of impairment, as well as

Patients with the most severe symptoms exhibited greater rates of impairment, as well as higher levels of anxiety, sadness, exhaustion, and sleep disturbances. All individuals who underwent mental treatments improved their symptoms, compared to 97% who got predominantly physical or occupational therapy and 83% who had little interventions.
In August 2022, the Brookings Institution projected that around 16 million working-age Americans (aged 18 to 65) have long COVID, with 2 to 4 million out of work as a result of long COVID.

Sakinah Sabadia, Ariane Lewis, Aaron Lord, MD; Kara Melmed, Sujata Thawani, Laura Balcer; Thomas Wisniewski, and Steven Galetta were among the authors of the JNS study from NYU Langone Health’s Department of Neurology. Dixon Yang of New York Presbyterian, Columbia Medical Center’s Department of Neurology; Adam de Havenon of Yale University School of Medicine’s Department of Neurology; and Shadi Yaghi of Brown University School of Medicine’s Department of Neurology were also authors.

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