{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T17:49:33Z","timestamp":1767980973175,"version":"3.49.0"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hospital S\u00e3o Paulo and the Department of Neurology and Neurosurgery, Federal University of S\u00e3o Paulo, Brazil"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals.<\/jats:p><jats:p>\n          Objective\u2003To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities.<\/jats:p><jats:p>\n          Methods\u2003Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital S\u00e3o Paulo (Federal University of S\u00e3o Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not.<\/jats:p><jats:p>\n          Results\u2003The mean age of the sample was 55\u2009\u00b1\u200915.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia\/hypogeusia (50%), orthostatic intolerance (49%), anosmia\/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia\/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85\u2009\u00b1\u200912.06 vs. 8.9\u2009\u00b1\u20098.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without).<\/jats:p><jats:p>\n          Conclusion\u2003A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia\/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia\/hyposmia.<\/jats:p>","DOI":"10.1055\/s-0043-1761433","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T23:36:41Z","timestamp":1679528201000},"page":"146-154","source":"Crossref","is-referenced-by-count":5,"title":["Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19"],"prefix":"10.1055","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8205-4816","authenticated-orcid":false,"given":"Renata Carvalho","family":"Cremaschi","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7810-4748","authenticated-orcid":false,"given":"Carla Alessandra Scorza","family":"Bahi","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9101-3170","authenticated-orcid":false,"given":"Angelo Amato Vincenzo de","family":"Paola","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Medicina, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-7679","authenticated-orcid":false,"given":"Jaquelina Sonoe Ota","family":"Arakaki","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Medicina, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4858-2778","authenticated-orcid":false,"given":"Paulo Roberto Abr\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Medicina, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6080-5693","authenticated-orcid":false,"given":"Nancy Cristina Junqueira","family":"Bellei","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Medicina, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-2757","authenticated-orcid":false,"given":"Vanderci","family":"Borges","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8482-3754","authenticated-orcid":false,"given":"Fernando Morgadinho Santos","family":"Coelho","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."},{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Psicobiologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1007\/s10072-020-04575-3","article-title":"Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients","volume":"41","author":"Y Yachou","year":"2020","journal-title":"Neurol Sci"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China","volume":"77","author":"L Mao","year":"2020","journal-title":"JAMA Neurol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.cell.2020.08.028","article-title":"Effects of COVID-19 on the Nervous System","volume":"183","author":"C Iadecola","year":"2020","journal-title":"Cell"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s13760-021-01851-7","article-title":"Neurological manifestations as prognostic factors in COVID-19: a retrospective cohort study","volume":"122","author":"P A Sampaio Rocha-Filho","year":"2022","journal-title":"Acta Neurol Belg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s12883-021-02152-5","article-title":"Neurological manifestations as the predictors of severity and mortality in hospitalized individuals with COVID-19: a multicenter prospective clinical study","volume":"21","author":"M Amanat","year":"2021","journal-title":"BMC Neurol"},{"issue":"13","key":"ref6","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1177\/0333102420966770","article-title":"Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia","volume":"40","author":"P AS Rocha-Filho","year":"2020","journal-title":"Cephalalgia"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1007\/s00405-020-05965-1","article-title":"Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study","volume":"277","author":"J R Lechien","year":"2020","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"102842","DOI":"10.1016\/j.autneu.2021.102842","article-title":"Syncope and silent hypoxemia in COVID-19: Implications for the autonomic field","volume":"235","author":"J Baker","year":"2021","journal-title":"Auton Neurosci"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s00415-021-10735-y","article-title":"Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study","volume":"269","author":"A Buoite Stella","year":"2022","journal-title":"J Neurol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.7861\/clinmed.2020-0896","article-title":"Autonomic dysfunction in \u2018long COVID\u2019: rationale, physiology and management strategies","volume":"21","author":"M Dani","year":"2021","journal-title":"Clin Med (Lond)"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"640835","DOI":"10.3389\/fnins.2021.640835","article-title":"Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus","volume":"15","author":"B Milovanovic","year":"2021","journal-title":"Front Neurosci"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.amjms.2020.07.022","article-title":"Dysautonomia: An Overlooked Neurological Manifestation in a Critically ill COVID-19 Patient","volume":"360","author":"N Eshak","year":"2020","journal-title":"Am J Med Sci"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1093\/gerona\/glaa183","article-title":"Preexisting Comorbidities Predicting COVID-19 and Mortality in the UK Biobank Community Cohort","volume":"75","author":"J L Atkins","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1159\/000516258","article-title":"Neurological Symptoms, Comorbidities, and Complications of COVID-19: A Literature Review and Meta-Analysis of Observational Studies","volume":"84","author":"K Vakili","year":"2021","journal-title":"Eur Neurol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"102841","DOI":"10.1016\/j.autneu.2021.102841","article-title":"Preparing for the long-haul: Autonomic complications of COVID-19","volume":"235","author":"N W Larsen","year":"2021","journal-title":"Auton Neurosci"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.mayocp.2012.10.013","article-title":"COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score","volume":"87","author":"D M Sletten","year":"2012","journal-title":"Mayo Clin Proc"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.pmrj.2015.08.008","article-title":"Patients With Fibromyalgia Have Significant Autonomic Symptoms But Modest Autonomic Dysfunction","volume":"8","author":"A Vincent","year":"2016","journal-title":"PM R"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s10286-020-00714-0","article-title":"The extended autonomic system, dyshomeostasis, and COVID-19","volume":"30","author":"D S Goldstein","year":"2020","journal-title":"Clin Auton Res"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s00415-020-09978-y","article-title":"Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature","volume":"268","author":"D T Di Carlo","year":"2021","journal-title":"J Neurol"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1515\/revneuro-2020-0108","article-title":"COVID-19 associated central nervous system manifestations, mental and neurological symptoms: a systematic review and meta-analysis","volume":"32","author":"S Soltani","year":"2021","journal-title":"Rev Neurosci"},{"issue":"12","key":"ref21","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1111\/ene.15072","article-title":"Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)","volume":"28","author":"N N Kleineberg","year":"2021","journal-title":"Eur J Neurol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/978-3-030-85113-2_7","article-title":"Risk Factors for COVID-19: Diabetes, Hypertension, and Obesity","volume":"1353","author":"S Buscemi","year":"2021","journal-title":"Adv Exp Med Biol"},{"issue":"12","key":"ref23","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.jiph.2020.07.014","article-title":"COVID-19 and comorbidities: Deleterious impact on infected patients","volume":"13","author":"H Ejaz","year":"2020","journal-title":"J Infect Public Health"},{"issue":"10","key":"ref24","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1038\/s41440-020-0515-0","article-title":"Hypertension and related diseases in the era of COVID-19: a report from the Japanese Society of Hypertension Task Force on COVID-19","volume":"43","author":"S Shibata","year":"2020","journal-title":"Hypertens Res"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"107406","DOI":"10.1016\/j.intimp.2021.107406","article-title":"Type 2 diabetes mellitus impaired nasal immunity and increased the risk of hyposmia in COVID-19 mild pneumonia patients","volume":"93","author":"Y Zhao","year":"2021","journal-title":"Int Immunopharmacol"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/chemse\/bjx070","article-title":"The Association Between Diabetes and Olfactory Function in Adults","volume":"43","author":"J YK Chan","year":"2017","journal-title":"Chem Senses"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"102365","DOI":"10.1016\/j.amjoto.2019.102365","article-title":"Relationship between progression of type 2 diabetes mellitus and olfactory function","volume":"41","author":"K S Kaya","year":"2020","journal-title":"Am J Otolaryngol"},{"issue":"06","key":"ref28","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1111\/dme.13310","article-title":"Validation of the Composite Autonomic Symptom Score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes","volume":"34","author":"C Greco","year":"2017","journal-title":"Diabet Med"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.2147\/DMSO.S214085","article-title":"Diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) in early detection of autonomic dysfunction in type 2 diabetes mellitus","volume":"12","author":"R Singh","year":"2019","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"07","key":"ref30","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1002\/alr.22579","article-title":"Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms","volume":"10","author":"C H Yan","year":"2020","journal-title":"Int Forum Allergy Rhinol"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s10286-018-0515-1","article-title":"Autonomic symptoms following Zika virus infection","volume":"28","author":"Y Rodr\u00edguez","year":"2018","journal-title":"Clin Auton Res"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.hrthm.2020.12.007","article-title":"The possible association between COVID-19 and postural tachycardia syndrome","volume":"18","author":"D S Goldstein","year":"2021","journal-title":"Heart Rhythm"},{"issue":"10","key":"ref33","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1080\/23744235.2021.1924397","article-title":"Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments","volume":"53","author":"S J Yong","year":"2021","journal-title":"Infect Dis (Lond)"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10286-021-00803-8","article-title":"Autonomic dysfunction following COVID-19 infection: an early experience","volume":"31","author":"K Shouman","year":"2021","journal-title":"Clin Auton Res"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"102872","DOI":"10.1016\/j.autneu.2021.102872","article-title":"Syncope and COVID-19 disease - A systematic review","volume":"235","author":"R F de Freitas","year":"2021","journal-title":"Auton Neurosci"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"102734","DOI":"10.1016\/j.autneu.2020.102734","article-title":"Syncope at SARS-CoV-2 onset","volume":"229","author":"C Canetta","year":"2020","journal-title":"Auton Neurosci"},{"issue":"11","key":"ref37","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1038\/s41582-020-0398-3","article-title":"Lifting the mask on neurological manifestations of COVID-19","volume":"16","author":"A Pezzini","year":"2020","journal-title":"Nat Rev Neurol"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/jmv.25728","article-title":"The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients","volume":"92","author":"Y C Li","year":"2020","journal-title":"J Med Virol"},{"issue":"04","key":"ref39","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10286-020-00715-z","article-title":"Is \u2018happy hypoxia\u2019 in COVID-19 a disorder of autonomic interoception? A hypothesis","volume":"30","author":"A Gonz\u00e1lez-Duarte","year":"2020","journal-title":"Clin Auton Res"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"e575","DOI":"10.1212\/WNL.0000000000010979","article-title":"A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City","volume":"96","author":"J A Frontera","year":"2021","journal-title":"Neurology"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1761433.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:37:31Z","timestamp":1683247051000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1761433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":40,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2023,3,22]]},"published-print":{"date-parts":[[2023,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1761433","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]}}}