After COVID-19: Chronic fatigue and cognitive impairment

After infection with SARS-CoV-2, significantly more people suffer from chronic fatigue syndrome than people who have not been in contact with the virus. Cognitive deficits such as concentration or memory disorders also occur more frequently after infection. As researchers at Charité – Universitätsmedizin Berlin and the University Hospital Schleswig-Holstein (UKSH), Kiel Campus, show in a recent study, predominantly young women are affected by fatigue syndrome. Mental impairment was observed more in men aged 55 and older, as the researchers report in the journal eClinicalMedicine*. The findings are based on extensive data from the COVIDOM study, a survey conducted as part of the National Pandemic Cohort Network (NAPKON).

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Postinfectious chronic fatigue syndrome, also known as fatigue, is characterized by long-term and severe physical weakness that does not improve even with sleep and rest. Often, worsening occurs even after minor exertion. Chronic fatigue is considered the main reason for reduced quality of life after COVID-19, and appropriate treatment options are lacking. To date, there have been no reliable figures for the incidence of late and long-term sequelae such as this after COVID-19, and data on the prevalence of fatigue in the population in other contexts also vary. “The existence and potential impact of chronic fatigue after COVID-19 are currently the subject of controversy. Our study now provides robust data based on broad population studies that are of societal importance,” said Prof. Dr. Carsten Finke, Department of Neurology with Experimental Neurology at Charité. “Long-lasting chronic fatigue after SARS-CoV-2 infection is definitely a common and relevant problem. The disease is associated with great personal suffering, leads to absenteeism at work and represents a considerable burden for the health care system.”

For the current study, the research team led by Prof. Finke and Prof. Dr. Walter Maetzler, Deputy Director of the Department of Neurology at UKSH, Kiel Campus, evaluated data from around 1,000 patients whose SARS-CoV-2 infection occurred at least six months previously. The comparison group without previous infection consisted of about 1,000 people whose data had been collected for a population study conducted by the University of Leipzig before the pandemic. About 19 percent of those previously infected with SARS-CoV-2 showed relevant symptoms of chronic fatigue syndrome, compared to only eight percent in the comparison group. Chronic fatigue thus occurs more than twice as frequently as in the healthy general population, even months after infection with the coronavirus. It particularly affects younger women between the ages of 18 and 24 as a result of infection. “We had not expected such high numbers or such a clear difference in a direct comparison with the general population,” said Prof. Finke. Neurological complaints during acute COVID-19 disease could be identified as risk factors for the later occurrence of fatigue.

According to the study, cognitive impairments such as concentration or memory disorders are another common consequence of coronavirus infection: they were seen in 27 percent of those examined. Symptoms of this type occurred mainly in older men. However, only a few of them complained of symptoms of chronic fatigue at the same time, while among patients between the ages of 25 and 54, about half suffered from fatigue and cognitive impairment. The research team concludes that factors independent of each other lead to the occurrence of these two common outcomes. Which of the different long-term and late sequelae show up after COVID-19 is most likely due to different mechanisms of development. “What is interesting to us now is whether the cognitive deficits are permanent or whether they regress. It is also an open question whether dementia develops earlier in the elderly as a result of SARS-CoV-2 infection,” says Prof. Maetzler. “The current data provide the first indications that chronic fatigue syndrome is less pronounced the longer the illness dates back.” Therefore, researchers are currently devoting particular attention to the course of these complaints.

*Hartung T. J. et al. Fatigue and cognitive impairment after COVID-19: A prospective multicentre study. eClinicalMedicine, Volume 53, 2022. doi: 10.1016/j.eclinm.2022.101651


In the COVIDOM study, which is being conducted as part of the National Pandemic Cohort Network (NAPKON/NAPKON-POP), researchers from UKSH, Charité and Würzburg University Hospital, Christian Albrechts University in Kiel and the Cluster of Excellence “Precision Medicine in Chronic Inflammation” are investigating the health consequences in SARS-CoV-2 infected individuals. NAPKON is a nationwide research platform on COVID-19 in which university hospitals and clinics and physician practices have formed a network to generate a clinical picture of the acute and long-term consequences of SARS-CoV-2 infection. The study is funded by the National University Medicine Research Network (NUM), which was initiated by the German Federal Ministry of Education and Research at the onset of the pandemic. Under the umbrella of the NUM, collaborative projects such as NAPKON, together with other components of the NUM, are creating fundamental infrastructures for successfully understanding and thus combating pandemics, using COVID-19 as an example.



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