Neuropsychiatric manifestations of Long COVID in India: a persistent problem 2.5 years after disease onset

Background Long COVID, also called post-acute sequelae of SARS-CoV-2 infection (PASC), is a multi-system syndrome affecting millions of people worldwide. Neuropsychiatric manifestations of Long COVID are particularly debilitating; however, they have not been reported in detail from India. Methods This cross-sectional study compared the demographics, comorbidities, symptoms, and neuropsychiatric profiles of patients with Long COVID symptoms that began within 3 months of the initial SARS-CoV-2 infection and persisted for approximately 2.5 years at the time of evaluation. The study was conducted at NIMS University (Jaipur, Rajasthan, India). Results Of 1,085 participants, 521 had COVID-19 pneumonia requiring hospitalization, while 564 had a mild initial respiratory presentation and were never hospitalized. On average 2.5 years after acute infection, our principal finding is that Long COVID differs based on initial disease severity. Post-hospitalization patients were older than the non-hospitalized group (43.24 vs. 36.15 years; p < 0.0001), had a higher body-mass index, and a more frequent prior history of lung disease (7.7% vs. 2.7%; p < 0.001). Overall, 69.6% of participants had at least one neurologic symptom, including myalgia (18.5%), dizziness (17.3%), headache (16.6%), pain (15.7%), anosmia (13.3%), brain fog (9.4%), numbness (6.0%), tinnitus (5.5%), and dysgeusia (3.7%), with only dizziness being more frequent in the post-hospitalization than the non-hospitalized group (20.3% vs. 14.5%; p = 0.012). Conversely, non-hospitalized patients had more frequent fatigue (23.2% vs. 6.0%; p < 0.0001), sleep problems (18.4% vs. 7.7%; p < 0.0001), chest pain (8.2% vs. 2.9%; p < 0.0001), and gastrointestinal symptoms (7.8% vs. 2.9%; p < 0.0001), while post-hospitalization patients more frequently complained of shortness of breath (9.6% vs. 2.7%; p < 0.0001). Overall, 4.9% of participants had cognitive dysfunction on the MMSE test, while 10.4% suffered from stress, and 12.7 and 9.2% had anxiety and depression symptoms, respectively, on DASS assessment, without significant differences between the two groups. Conclusion Our study highlights differences in demographics and clinical presentation of Long COVID between post-hospitalization and non-hospitalized individuals in India. The high frequency of neurologic manifestations 2.5 years after disease onset underscores the need for early detection and targeted interventions.