Acute neurological and neuropsychiatric complications of COVID-19 affect up to 20-30% of hospitalised patients, including encephalopathy, encephalitis, catatonia, psychosis, 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 and neuropsychiatric complications of COVID-19 and their sequelae.

In collaboration with CoroNerve and ISARIC-4C’s we have already identified patients who have been hospitalised with these complications. We will invite these and new patients, to join the COVID-19 Clinical Neuroscience Study (COVID-CNS), part of the COVID-19 section of the NIHR BioResource.

We will determine the phenotypes, biomarkers and genotypes of these patients relative to previously hospitalised controls including those from ISARIC-4C’s and PHOSP-COVID (COVID-19 and non-COVID). We will collect data from clinical cases notes and electronic records, then assess neurological/cognitive/psychiatric sequelae post-discharge. We will analyse brain injury, virologic, and immunological mechanisms in serum and cerebrospinal fluid, and acute and follow up 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 the WHO commissioned COVID-19 Neuro Research Coalition Task Force to have immediate impact on patient care and through our PPI programme. The NIHR BioResource will provide sustainability and, through linkage to the community cohort, will allow us to determine if similar, but milder, symptoms are being experienced more widely.