长新冠患者的大脑结构、功能发生变化

—焦虑、抑郁患者的灰质萎缩、脑功能过度连接

 

概要

 

在美国神经病学学会年度会议提前公开的摘要中，发布了一项针对长新冠患者脑部的研究。研究显示，患有长新冠并在轻度感染后经历焦虑和抑郁的人大脑可能会发生结构和功能的变化。

在本项研究中，来自圣保罗坎皮纳斯大学的团队评估了254名3个月前患有轻症新冠的病例。该组中，102人（40.2%）同时有焦虑和抑郁症状，152人（59.8%）没有症状。平均年龄为41岁的参与者也接受了脑部扫描。

研究人员将扫描结果与148名未感染COVID-19的人的扫描结果进行了比较。经历焦虑、抑郁情绪的长新冠患者的大脑边缘区域萎缩，该区域涉及记忆和情绪处理。然而，没有焦虑和抑郁情绪的新冠患者的脑部扫描显示没有萎缩迹象。使用跟踪三组大脑活动的软件进行测试发现，患有焦虑、抑郁症的新冠患者的大脑在测试12个网格中都有广泛的功能变化。没有经历过焦虑和抑郁的COVID 患者仅在5个网格中发生了变化。

研究人员认为，焦虑和抑郁是SARS-CoV-2引起的神经损伤的表现。假设小胶质细胞在一些新冠患者体内被激活，随之而来的炎症反应会产生一种破坏神经元健康的环境，致使患者自身免疫系统发生一系列连锁反应。而随后出现的灰质萎缩及脑部功能受损的变化的幅度表明长新冠与认知功能障碍有关，因此患有长新冠的焦虑症和抑郁症患者大脑的交流方式及其结构发生了严重的变化。

 

Brain Structure, Widespread Connectivity Changes Seen With Long COVID

—Gray matter atrophy, hyperconnectivity in patients with anxiety, depression

 

 

Gray matter atrophy and severe disruption of brain functional connectivity were seen in long COVID patients with anxiety and depression about 3 months after acute mild SARS-CoV-2 infection.

 

Compared with people who were asymptomatic after SARS-CoV-2 infection, long COVID patients with both anxiety and depression showed limbic atrophy and a widespread pattern of hyperconnectivity, reported Clarissa Yasuda, MD, PhD, of the University of Campinas in São Paulo, Brazil, and colleagues, in an abstract released in advance of the American Academy of Neurology annual meeting.

 

The magnitude of changes suggest an association with cognitive dysfunction, they observed.

 

"Our results suggest a severe pattern of changes in how the brain communicates as well as its structure, mainly in people with anxiety and depression with long COVID syndrome, which affects so many people," Yasuda said in a statement. "Our findings are concerning, as even people with a mild case of COVID-19 are showing changes in their brains months later."

 

The findings add to the growing body of evidence that show brain structure and function are affected by SARS-CoV-2, noted Ziyad Al-Aly, MD, director of the clinical epidemiology center and chief of research and development at the VA St. Louis Health Care System, who wasn't involved with the study.

 

"Anxiety and depression are manifestations of the neurologic damage caused by SARS-CoV-2 and this abstract provides further objective evidence of structural and functional alteration in the brain following SARS-CoV-2 infection," Al-Aly told MedPage Today. "Our understanding of this is evolving, but clearly infection with SARS-CoV-2 can affect the brain."

 

Many studies have shown brain problems persistopens in a new tab or window long after acute infection, with some symptoms lasting as long as 2 yearsopens in a new tab or window, but why this happens isn't clear.

 

"Some hypothesize that microglia are activated in some people with SARS-CoV-2 and that the inflammatory response that ensues creates a milieu that is disruptive to neuronal health," Al-Aly said. "Other hypotheses revolve around autoimmunity. At this point, we are still learning more and more every day."

 

Yasuda and colleagues evaluated 254 individuals with mild COVID-19 a median of 82 days from RT-PCR test with Beck Depression Inventory and Beck Anxiety Inventory tests. The overall sample included 177 women with a median age of 41.

 

Participants were separated into asymptomatic (152 people) and simultaneous (102 people with simultaneous anxiety and depression symptoms based on test scores) groups.

 

Gray matter atrophy was assessed with voxel-based morphometry comparing the two groups with 148 healthy controls on MRI. Connectivity data were evaluated with resting-state MRI of 12 large-scale brain networks in 84 people in the asymptomatic group, 70 people in the simultaneous group, and 90 controls. The researchers reported results with P<0.05.

 

In the simultaneous group, gray matter atrophy was seen in the left cingulum (86 voxels) and the inferior frontal lobe (91 voxels). The asymptomatic group had no gray atrophy.

 

The simultaneous group presented a widespread, bilateral pattern of hyperconnectivity involving all 12 networks; the asymptomatic group showed hyperconnectivity involving only five networks.

 

"This abstract, along with all the other evidence, is a compelling reason to double our effort to further understand long COVID and its various sequelae or consequences," Al-Aly said.

 

"Understanding the long-term health effects of SARS-CoV-2 infection will not only help us understand long COVID, but more broadly will deepen our understanding of infection-associated chronic illnesses -- an entity that has been ignored for more than 100 years," he added. "It will also help prepare us better for the next pandemic."

 

Source:

Medpage Today

Published on February 20 2023

 

 

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