Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

Autor: Luca Sebastianelli, Raffaele Nardone, Michael Engl, Giacomo Koch, Ilenia Bonini, Viviana Versace, Leopold Saltuari, Roberto Romanello, Davide Ferrazzoli, Antonio Oliviero, Angelo Quartarone, Markus Kofler, Paola Ortelli
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_treatment
RT
reaction time
Action Potentials
FRS
Fatigue Rating Scale
Neuropsychological Tests
Executive Function
0302 clinical medicine
80 and over
Medicine
Apathy
030212 general & internal medicine
Neuropsychological assessment
Evoked potential
TMS
Transcranial magnetic stimulation
Evoked Potentials
Problem Solving
Fatigue
Aged
80 and over
AES
Apathy Evaluation Scale
CMAP
compound muscle action potential
medicine.diagnostic_test
Peripheral fatigue
Central fatigue
COVID-19
Dysexecutive syndrome
Peripheral fatigue
TMS
Neuropsychology
Motor Cortex
RMT
resting motor threshold
Skeletal
Middle Aged
HC
healthy control
Transcranial Magnetic Stimulation
Compound muscle action potential
CNS
Central Nervous System
Neurology
Motor
CRP
C-reactive protein
Muscle
BDI
Beck Depression Inventory
Female
medicine.symptom
MoCA
Montreal Cognitive Assessment
medicine.medical_specialty
IL-6
interleukine-6
Central fatigue
COVID-19
Dysexecutive syndrome
TMS
Aged
Evoked Potentials
Motor
Humans
Muscle
Skeletal
Clinical Neurology
Neurophysiology
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
Article
NO
03 medical and health sciences
Physical medicine and rehabilitation
FDI
first dorsal interosseous muscle
SP
silent period
SARS-CoV-2
business.industry
VT
vigilance task
Beck Depression Inventory
FAB
Frontal Assessment Battery
FSS
Fatigue Severity Scale
Transcranial magnetic stimulation
SIT
Stroop Interference Task
MEP
motor evoked potential
CR100
Borg-Category-Ratio scale
Silent period
Neurology (clinical)
business
NV
Navon Task
030217 neurology & neurosurgery
Zdroj: Journal of the Neurological Sciences
Popis: More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale. Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS. Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABAB-ergic dysfunction. This impairment might be related to the neuropsychological alterations. COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits.
Highlights • Neuropsychological and neurophysiological features of fatigue were studied in post-COVID-19 patients. • Apathy, deficits in executive functions and reduction in global cognition were found. • Abnormal shortening of cortical silent period and lack of MEP depression were demonstrated after a fatiguing task. • Disruption of post-exhaustion corticomotor inhibition suggests GABA-ergic dysfunction. • GABA-ergic impairment might subtend fatigue and executive deficits in COVID-19.
Databáze: OpenAIRE
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