The COVID-19: Clinical Neuroscience Study (COVID-CNS)

Acute neurological complications of COVID-19 affect 20-30% of hospitalised patients, including encephalopathy/delirium, encephalitis, stroke, and Parkinsonism. These are often otherwise unexplained (i.e. excluding risk factors/hypoxia/iatrogenic causes) and often occur in younger patients. Survivors frequently report cognitive impairment,fatigue, and depression. The limited regenerative capacity of the brain means these complications may cause lifelong disability. There is an urgent, unmet need to understand the biological causes of acute neurological complications of COVID-19 and their sequelae. In collaboration with CoroNerve and ISARIC-4C's we have already identified 800 patientswho have been hospitalised with these complications. We will invite these patients to join the COVID-CNS NIHR BioResource, using existing HRA approvals and protocols.We will conduct a case control study to determine the phenotypes and genotypes ofthese patients relative to 500 previously hospitalised controls including those from ISARIC-4C's and PHOSP-COVID (400 with COVID-19; 100 non-COVID). We will collect datafrom clinical cases notes and electronic records, then assess neurological/cognitive/psychiatric sequelae at 3-6 months post-discharge We will analyse brain injury, virologic, and immunological mechanisms in serum and cerebrospinal fluid, and analyse acute MRI's and, at follow up, functional MRI to study the pathophysiology of these complications.By understanding these mechanisms, we will be able to stratify patients into clinical care pathways and into trials using existing and novel therapies. We will apply this knowledge through our WHO-commissioned Task Force (co-Chair Michael) to have immediate impacton patient care and through our PPI programme.The NIHR BioResource will provide sustainability (ALREADY FUNDED) and, through linkage to the community cohort (n=35,000), will allow us to determine if similar, but milder, symptoms are being experienced more widely.