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Título

NEUROPSYCHOLOGICAL ALTERATIONS AND PET/CT ABNORMALITIES AFTER COVID-19 INFECTION: CASE REPORT

RESUMO

CASE REPORT: A 75-year-old woman, diabetic, less than 4 years of schooling, no past or family history of dementia or psychiatric disorder, presented with sudden behavioral change after COVID-19 infection in April of 2021. Throughout the infection, the patient had fever, anosmia, with no need of hospitalization. After 14 days, exhibited infantilized behavior, dysarthria and did not recognize her family members, mistaking her daughter for her own mother. The Addenbrooke's Cognitive Examination-Revised (ACE-R) and Neupsilin were administered, revealing executive dysfunction, visuospatial impairment, deficits in working memory, language and sustained attention. Patient remains stable after one-year follow-up. Cerebral Magnetic Resonance Imaging (MR) with MR angiography, CSF analysis and laboratory studies identified no abnormalities. Positron Emission Tomography (PET/CT), after F18-FDG injection, showed discrete diffuse cortical hypometabolism, with bilateral frontal, posterior temporal, bilateral parietal, precuneus and cingulate gyrus predominance, not suggestive of vascular dementia. DISCUSSION: Cognitive impairment is a complication of COVID-19, that usually initiates during the diasease's acute or subacute phase and improves a few months afterwards. Memory and attention deficits are the most common symptoms. In this case, the impairment persists after a one-year course and, unlike late-onset Alzheimer Disease (AD), exhibits disexecutive predominance. Identification of vascular and inflammatory lesions in MR images has assisted in comprehending its pathophysiology, however they were not present in this patient's exams. On the other hand, it needs to be clarified whether COVID-19 can influence the development of dementias, such as AD, accelerating its course, as it is suggested in this case. Cerebral PET and SPECT findings, despite the variety of possibilities, always show, after COVID-19, hypometabolism with frontoparietal or bilateral frontal predominance. The recent finding that SARS-CoV-2 infection induces hypometabolism in brain areas that are affected by neurodegenerative diseases will contribute to better comprehend the neuropsychological profiles in mixed cases of COVID-19 and AD. CONCLUSION: It was presented probably new dementia syndrome characterized by the sudden beginning, prolonged and fluctuating course after COVID-19.

Palavras Chave

COVID-19; Dementia; Neuropsychology; Positron-Emission Tomography; Follow-Up Studies