Correlation between Acute Phase Symptoms with Neurological Long Covid Symptoms on COVID-19 Survivors

Ahmad Rizal Ganiem, Siuliyanty Siuliyanty, Anam Ong, Uni Gamayani, Lisda Amalia, Yusuf Wibisono


Objective: To investigate prolonged neurological impacts of COVID-19 and establish a connection between initial COVID-19 symptom severity and chronic fatigue syndrome (CFS) development, poor sleep quality (PSQ), and cognitive impairment (CI) in individuals recovered from COVID-19.

Methods:  This cross-sectional study recruited COVID-19 survivors at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between June and December 2021. All participants gave informed consent and underwent interviews on demography, clinical features, long-COVID questionnaire, and neurological examination. Participants underwent cognitive examination (MOCA-INA), Chalder Fatigue Scale and Pittsburgh Sleep Quality Index (PSQI) to assess CI, CFS, and PSQ variables. Chi-Square analysis was performed to determine the probability of neurological long COVID-19 syndrome manifestations using SPSS 24.0.

Results: Of the 127 participants recruited, 67.7% were women, median (IQR) age of 33 (21-65) years, and time from hospitalization to examination of nine months (1-13). The most common neurological Long COVID symptoms were PSQ (59.8. %), CFS (51.2%), and CI (33.9%). Participants with more than five acute phase COVID-19 symptoms had a higher probability of CFS and CI (OR 2.38 (1, 16-4.9, CI 95%); OR 2.20 (1.01-4.79, CI 95%)) than those with less than five symptoms. The study did not find a significant correlation between sleep quality and number of acute-phase COVID-19 symptoms (OR 1.56 (0.76-3.20, CI 95%)).

Conclusion: Almost two-thirds of the COVID-19 survivors experienced PSQ, more than half had CFS, and almost one-third had CI. The study revealed an increasing likelihood of CFS and CI in COVID-19 survivors as the number of acute COVID-19 symptoms increases.


Chronic fatigue syndrome; cognitive impairment; Long COVID; poor sleep quality

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  1. DeKosky ST, Kochanek PM, Valadka AB, Clark RSB, Chou SH, Au AK, et al. Blood Biomarkers for Detection of Brain Injury in COVID-19 Patients. J Neurotrauma. 2021;38(1):1–43. doi:10.1089/neu.2020.7332
  2. WHO. WHO COVID-19. WHO; 2021. Available from:
  3. Satuan Tugas Penanganan COVID-19. Peta Sebaran COVID-19 [Internet]. 2021. Available from: Available from:
  4. Morley JE. Editorial: COVID-19 - The Long Road to Recovery. J Nutr Health Aging. 2020;24(9):917–9. doi:10.1007/s12603-020-1473-6
  5. Rambe AS, Fitri FI. Correlation between the Montreal Cognitive Assessment-Indonesian Version (Moca-INA) and the Mini-Mental State Examination (MMSE) in Elderly. Open Access Maced J Med Sci. 2017;5(7):915–9. doi:10.3889/oamjms.2017.202
  6. Jackson C. The Chalder Fatigue Scale (CFQ 11). Occup Med (Lond). 2015;65(1):86. doi:10.1093/occmed/kqu168
  7. Setyowati A, Chung MH. Validity and reliability of the Indonesian version of the Pittsburgh Sleep Quality Index in adolescents. Int J Nurs Pract. 2021;27(5):e12856. doi:10.1111/ijn.12856
  8. Wang Y, Sibaii F, Lee K, J. Gill M, L. Hatch J. NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 1. medRxiv. 2021;1(165):1–13.
  9. Del Brutto OH, Rumbea DA, Recalde BY, Mera RM. Cognitive sequelae of long COVID may not be permanent: A prospective study. Eur J Neurol. 2022;29(4):1218–21. doi:10.1111/ene.15215
  10. Liu YH, Wang YR, Wang QH, Chen Y, Chen X, Li Y, et al. Post-infection cognitive impairments in a cohort of elderly patients with COVID-19. Mol Neurodegener. 2021;16(1):1–10.
  11. Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. 2022;28(4):611.e9-611.e16. doi:10.1016/j.cmi.2021.11.002
  12. Desdiani D, Sutarto AP, Kharisma AN, Safitri H, Hakim AF, Rusyda SH. Sequelae in COVID-19 patients 3 months after hospital discharge or completion of self-isolation. Health Sci Rep. 2021;4(4):e444. doi:10.1002/hsr2.444
  13. Dennis A, Wamil M, Alberts J, et al. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ Open. 2021;11(3):e048391. doi:10.1136/bmjopen-2020-048391
  14. Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis of COVID-19: A systematic review. Diabetes Metab Syndr. 2020;14(4):655–9. doi:10.1016/j.dsx.2020.05.020
  15. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069–76. doi:10.1007/s42399-020-00363-4
  16. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–32. doi:10.1016/S0140-6736(20)32656-8
  17. Zapatero DZ, Hanquet G, Heede K Van Den. Epidemiology of long COVID: a pragmatic review of the literature. KCE. 2021;1–16.
  18. Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021;114(9):428–42. doi:10.1177/01410768211032850
  19. National Institute for Health and Care Excellence (NICE) SIGN (SIGN) and RC of GP (RCGP). Covid19-Rapid-Guideline-Managing-the-Longterm-Effects-of-Covid19-Pdf-51035515742. 114 Publ 01032022. 2022;1–106.
  20. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–15. doi:10.1038/s41591-021-01283-z
  21. Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Prevalence and determinants of fatigue after covid-19 in non-hospitalized subjects: a population-based study. Int J Environ Res Public Health. 2021;18(4):2030. doi:10.3390/ijerph18042030
  22. Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FVC, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?. ERJ Open Res. 2020;6(4):00542–2020. doi:10.1183/23120541.00542-2020
  23. Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 2020;15(11):e0240784. doi:10.1371/journal.pone.0240784
  24. Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A,, et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis. 2022;74(7):1191–8. doi:10.1093/cid/ciab611
  25. Miskowiak KW, Fugledalen L, Jespersen AE, Sattler SM, Podlekareva D, et al. Trajectory of cognitive impairments over 1 year after COVID-19 hospitalisation: Pattern, severity, and functional implications. Eur Neuropsychopharmacol. 2022;59:82–92. doi:10.1016/j.euroneuro.2022.04.004
  26. Fernández-de-Las-Peñas C, Torres-Macho J, Elvira-Martínez CM, Molina-Trigueros LJ, Sebastián-Viana T, Hernández-Barrera V. Obesity is associated with a greater number of long-term post-COVID symptoms and poor sleep quality: A multicentre case-control study. Int J Clin Pract. 2021;75(12):e14917. doi:10.1111/ijcp.14917
  27. Bhaskar S, Sinha A, Banach M, Mittoo S, Weissert R, Kass JS, et al. Cytokine Storm in COVID-19-immunopathological mechanisms, clinical considerations, and therapeutic approaches: The REPROGRAM consortium position paper. Front Immunol. 2020;11:1648. doi:10.3389/fimmu.2020.01648
  28. Vitale JA, Perazzo P, Silingardi M, Biffi M, Banfi G, Negrini F. Is disruption of sleep quality a consequence of severe Covid-19 infection? A case-series examination. Chronobiol Int. 2020;37(7):1110–14. doi:10.1080/07420528.2020.1775241


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