{"doi":"10.1002/ana.27128","title":"Neurologic Manifestations of Long <scp>COVID</scp> Disproportionately Affect Young and Middle‐Age Adults","abstract":"OBJECTIVE: To investigate neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients across the adult lifespan. METHODS: Cross-sectional study of the first consecutive 200 PNP and 1,100 NNP patients evaluated at a Neuro-coronavirus disease 2019 (COVID-19) clinic between May 2020 and March 2023. Patients were divided into younger (18-44 years), middle-age (45-64 years), and older (65+ years) age groups. RESULTS: Younger and middle-age individuals accounted for 142 of 200 (71%) of PNP and 995 of 1100 (90.5%) of NNP patients. Significant age-related differences in the frequencies of comorbidities and abnormal neurologic findings demonstrated higher prevalence in older patients. Conversely, 10 months from COVID-19 onset, we found significant age-related differences in Neuro-PASC symptoms indicating lower prevalence, and therefore, symptom burden, in older individuals. Moreover, there were significant age-related differences in subjective impression of fatigue (median [interquartile range (IQR)] patient-reported outcomes measurement information system [PROMIS] score: younger 64 [57-69], middle-age 63 [57-68], older 60.5 [50.8-68.3]; p = 0.04) and sleep disturbance (median [IQR] PROMIS score: younger 57 [51-63], middle-age 56 [53-63], older 54 [46.8-58]; p = 0.002) in the NNP group, commensurate with higher impairment in quality of life (QoL) among younger patients. Finally, there were significant age-related differences in objective executive function (median [IQR] National Institutes of Health [NIH] toolbox score: younger 48 [35-63], middle-age 49 [38-63], older 54.5 [45-66.3]; p = 0.01), and working memory (median [IQR] NIH toolbox score: younger 47 [40-53], middle-age 50 [44-57], older 48 [43-58]; p = 0.0002) in NNP patients, with the worst performance coming from the younger group. INTERPRETATION: Younger and middle-age individuals are disproportionally affected by Neuro-PASC regardless of acute COVID-19 severity. Although older people more frequently have abnormal neurologic findings and comorbidities, younger and middle-age patients suffer from a higher burden of Neuro-PASC symptoms and cognitive dysfunction contributing to decreased QoL. Neuro-PASC principally affects adults in their prime, contributing to profound public health and socioeconomic impacts warranting dedicated resources for prevention, diagnosis and interventions. 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Perez Giraldo","orcid":null,"position":4,"is_corresponding":false},{"id":1030404,"name":"Millenia Jimenez","orcid":null,"position":5,"is_corresponding":false},{"id":1029910,"name":"Janet L. Miller","orcid":"0000-0002-2292-5501","position":6,"is_corresponding":false},{"id":865035,"name":"Melissa Lopez","orcid":"0000-0003-4020-7092","position":7,"is_corresponding":false},{"id":903246,"name":"Barbara A. Hanson","orcid":null,"position":8,"is_corresponding":false},{"id":1210525,"name":"Aasheeta Parikh Bawa","orcid":null,"position":9,"is_corresponding":false},{"id":282272,"name":"Ayush Batra","orcid":"0000-0002-4783-5801","position":10,"is_corresponding":false},{"id":366288,"name":"Eric M. Liotta","orcid":"0000-0003-3182-585X","position":11,"is_corresponding":false},{"id":421942,"name":"Igor J. Koralnik","orcid":"0000-0001-6836-1468","position":12,"is_corresponding":false},{"id":1209986,"name":"Natasha A. 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