July 14, 2020

Evidence of Central Nervous System Involvement With COVID-19

Depressed mood or anxiety exhibited in patients with coronavirus disease 2019 (COVID-19) may possibly be a sign the virus affects the central nervous system, according to a study published in Laryngoscope.

Depressed mood and anxiety were most closely associated with a loss of smell and taste rather than the more severe indicators of COVID-19, such as shortness of breath, cough, and fever.

“If you had asked me why would I be depressed or anxious when I am COVID-positive, I would say it is because my symptoms are severe and I have shortness of breath or I can’t breathe or I have symptoms such as cough or high fever,” explained Ahmad Sedaghat, MD, University of Cincinnati College of Medicine, Cincinnati, Ohio. “None of these symptoms that portended morbidity or mortality was associated with how depressed or anxious these patients were. The only element of COVID-19 that was associated with depressed mood and anxiety was the severity of patients’ loss of smell and taste. This is an unexpected and shocking result.”

The researchers conducted a prospective, cross-sectional telephone questionnaire study which examined characteristics and symptoms of 114 patients who were diagnosed with COVID-19 over a 6-week period at Kantonsspital Aarau, Aarau, Switzerland. Severity of loss of smell or taste, nasal obstruction, excessive mucus production, fever, cough, and shortness of breath during COVID-19 were assessed.

When participants were experiencing COVID-19, 47.4% reported at least several days of depressed mood per week while 21.1% reported depressed mood nearly every day. In terms of severity, 44.7% of participants reported expressing mild anxiety while 10.5% reported severe anxiety.

“The unexpected finding that the potentially least worrisome symptoms of COVID-19 may be causing the greatest degree of psychological distress could potentially tell us something about the disease,” said Dr. Sedaghat. “We think our findings suggest the possibility that psychological distress in the form of depressed mood or anxiety may reflect the penetration of SARS-CoV-2, the virus that causes COVID-19, into the central nervous system.”

He noted that researchers have long thought that the olfactory tract may be the primary way that coronaviruses enter the central nervous system. There was evidence of this with SARS.

“These symptoms of psychological distress, such as depressed mood and anxiety are central nervous system symptoms if they are associated only with how diminished is your sense of smell,” said Dr. Sedaghat. “This may indicate that the virus is infecting olfactory neurons, decreasing the sense of smell, and then using the olfactory tract to enter the central nervous symptom. There may be more central nervous system penetration of the virus than we think based on the prevalence of olfaction-associated depressed mood and anxiety and this really opens up doors for future investigations to look at how the virus may interact with the central nervous system.”

Reference: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.28964

SOURCE: University of Cincinnati
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