Background and objectives To explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge. Methods Adult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed. Results At baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up. Discussion COVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time.

Given the evidence of long-term neurological complications following COVID-19, including cognitive impairment1, we aimed at assessing EEG cortical source densities (CSD) and linear lagged connectivity (LLC) values and their clinical, structural brain MRI and neuropsychological correlates in patients with recent COVID-19. We enrolled 49 adult patients with recent COVID-19, good recovery and cognitive disturbances, observed at 2-months post-discharge evaluation. Same-day 19-channel EEG and neuropsychological testing battery were performed; 36/49 patients underwent also 3T MRI. Thirty-three retrospective, age-/sex-matched healthy controls were selected, having no history of neurological or cognitive disturbances. Using low-resolution brain electromagnetic tomography (eLORETA) solutions at fixed frequencies2, EEG lobar CSD and LLC values of COVID-19 and healthy subjects were investigated. Correlations with cognitive scores, recent and past medical history and white matter hyperintensities (WMH) volume were explored. Patients showed pathological scores in memory, executive and visuo-spatial functions. 14/49 patients had symptoms suggestive of reactive depression. Analysis at delta frequency band (1.5-4.0 Hz) revealed higher CSD within bilateral frontal-temporal regions and greater LLC values between right frontal lobe and bilateral temporal and parietal-occipital lobes in COVID-19 patients. Delta CSD and LLC values positively correlated with executive performances, whereas no significant correlations were found with WMH, past and recent medical history. Differently from our acute-phase study3, EEG alterations after COVID-19 might be at least partially independent of acute infection severity and suggest instead a link with ongoing neuro-psychiatric symptoms. 8-months follow-up data will confirm the reversibility and/or evolution of our findings.

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We report a rare task-specific dystonia1,2 in a 26-year-old man with a 4-year progressive speech disorder characterized by oromandibular spasms. Family and medical history were unremarkable; he was never exposed to neuroleptic drugs or toxic agents. Neurologic examination revealed only speech-induced oromandibular dystonic movements, characterized by forced jaw opening, interfering with speech (video on the Neurology ® Web site at [www.neurology.org][1]). However, he was able to sing and to perform other voluntary activities (swallowing, drinking, chewing). Laboratory tests and brain magnetic resonance scans were normal. He received a placebo injection with no benefit. Trihexyphenidyl was started with moderate benefit. This rare form of dystonia is sometimes trig-gered by praying,1,2 resembling task-specific occupational dystonias. [1]: http://www.neurology.org