Neurologic Manifestations of Long COVID Disproportionately Affect Younger and Middle-Age Adults

Younger and middle-aged adults appear to be disproportionately impacted by neurologic symptoms of long COVID, according to a study published in the Annals of Neurology. The findings reveal unique age-related differences in symptom burden, cognitive performance, and quality of life, particularly in nonhospitalized patients.

Study Details and Age-Related Patterns

The study, led by Natasha A. Choudhury, M.D., from Northwestern University Feinberg School of Medicine, analyzed 200 posthospitalization Neuro-PASC and 1,100 nonhospitalized Neuro-PASC (NNP) patients seen at a Neuro-COVID-19 clinic between May 2020 and March 2023. Patients were divided into three age groups: younger (18 to 44 years), middle-aged (45 to 64 years), and older adults (65+ years).

Researchers found significant age-related differences in comorbidities and abnormal neurologic findings, which were more prevalent in older adults. However, at 10 months post-COVID-19 onset, older individuals reported a lower overall prevalence and burden of neurologic symptoms.

Greater Burden for Younger Adults

In the nonhospitalized group, younger and middle-aged adults experienced more pronounced neurologic symptoms. They reported higher levels of fatigue and sleep disturbances, which corresponded with greater impairments in quality of life. Additionally, younger patients showed the worst performance in objective tests of executive function and working memory compared to older groups.

"The impact of this condition causing disproportionate morbidity and disability in younger adults in their prime, who provide much of the workforce, productivity, and innovation in our society, may lead to critical issues of increased health care system burden, mental health crisis, socio-cultural deterioration, and economic recession," the authors write.

Why It Matters

These findings highlight the need to better understand and address the neurologic impacts of long COVID across different age groups. While older adults may face more comorbidities, the disproportionate burden on younger and middle-aged adults—who are often in the workforce—has broader societal and economic implications.

Further research is essential to identify mechanisms driving these age-related differences and to inform targeted strategies for mitigating long-term neurologic sequelae in younger populations.