Post-Concussion Assessment as a diagnostic and mechanistic framework for treating patients with Long COVID

Abstract Introduction Despite first coming into view over two years ago, effective diagnostic and treatment pathways for Long COVID continue to evade the medical community. The overlap in neurological-based symptoms and neuroinflammatory origin indicates that the framework of post-concussion syndrome may provide insight into new diagnostics and treatment for patients with Long COVID. The objective of this investigation was to determine whether tools from the four common domains of concussion assessment were sensitive to differentiate between patients with Long COVID from a reference group who was infected with Sars-CoV-2 and does not have Long COVID. Methods In this prospective cohort design, each participant self reported their group (Acute, n=28) and Long COVID Group (n=33). Each participant underwent an examination in four assessment categories: symptoms, vestibular nystagmography, Automated Neuropsychological Assessment Metrics (ANAM), and a series of balance tasks. Results Total Symptom scores were separated into functional classifications and showed clear success as a tool to differentiate between Acute and Long COVID. Five of the 33 people in the Long COVID had detectable central lesions, which increases the risk of developing long COVID by 64% (Relative Risk=1.64). A wide variety of objective and quantitative measures from post-concussion care are sensitive to the Long COVID condition. Prolonged latency during random saccades eye tracking was present (p<0.01, d=0.87) in the Long COVID group corresponding to the King-Devick rapid reading test, which was highly sensitive to Long COVID (p<0.01, d=1.34). ANAM reaction time subtests had similarly large effects (p<0.01, d=0.93-1.09). Balance performance with corrupted sensory feedback was also sensitive (p<0.01, d=0.96). Discussion Our results indicate that long-standing and validated post-concussion symptom questionnaires may be used for quantifying the severity of Long COVID. Some of the most sensitive measures (especially the King-Devick rapid reading test) are easy to implement clinically and may be effective at tracking patient progress in the context of Long COVID treatment. The results point to wide deficits in motor integration and provide a rationale for treating the subset of Long COVID patients with similar rehabilitation strategies as patients with post-concussion syndrome.