How does COVID-19 affect the brain?
Dr Tim Nicholson [pictured right], from King’s Health Partners Neurosciences, shares some of the ways he and his colleagues have been researching the brain complications of severe COVID-19 infection since the beginning of the pandemic.
Dr Tim Nicholson, please tell us about yourself and your role at King’s Health Partners.
I am a Clinical Senior Lecturer at the Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London and an Honorary Consultant Neuropsychiatrist at the South London and Maudsley NHS Foundation Trust.
My role involves running a national neuropsychiatry outpatient clinic specialising in Functional Neurological Disorder at the Maudsley Hospital. I have also helped to design and set up a long COVID clinic within King’s Health Partners, which will launch later this month.
I am the Director of the MSc in Clinical Neuropsychiatry at the IoPPN.
Please could you describe how the research you are involved in at King’s Health Partners Neurosciences’ is supporting the response to COVID-19?
1. A modern and cutting-edge approach to summarising the neurological and psychiatric effects of COVID-19
Due to COVID-19 symptoms, such as a loss or change to sense of smell or taste, it was clear early on that the virus may have a potential effect on the brain.
Jonathan Rogers, from the Division of Psychiatry, University College London, and Edward Chesney, who is affiliated with South London and Maudsley NHS Foundation Trust and the Department of Psychosis Studies at King's College London, together with other colleagues from King’s College London, helped to provide a useful synthesis of all the evidence from previous serious coronaviruses, such as SARS and MERS viruses, in the Lancet Psychiatry. They also reviewed the neuropsychiatric complications of the virus.
Following this, the data was coming in quickly through case reports and small initial studies. My colleagues and I within the neuropsychiatric community needed to speed up the way we shared new research findings and data on the complications of COVID-19. The usual framework for building evidence bases around a new area of research is a systematic review of the last year’s research. This is a process that can take a minimum of three months and more often closer to six. It then takes around two years or to produce the data. Synthesising all the evidence, getting it peer reviewed and published, can take some time. That process was sped up during the COVID-19 pandemic by putting out pre-prints, a version of a scholarly or scientific paper that precedes formal peer review and publication.
There have also been developments in systematic reviews due to COVID-19. Normally a ‘living’ systematic review is set up and churns out data on a regular basis, which requires a significant resource. My colleagues and I set up an innovative alternative by establishing a blog on the Journal of Neurology, Neurosurgery and Psychiatry, one of the leading journals at the interface of neurology and psychiatry. We had a team doing research every week for papers in neuropsychiatry and COVID-19. It started off as a handful of us, now it is a team of thirty international researchers. This was a cutting-edge way of putting the data out for everyone to keep up to speed with rapid developments.
You can read more about the formal systematic review of the prevalence of neuropsychiatric complications of COVID-19 in our pre-print published on 24 February 2021.
2. Public awareness
The blog team have also been involved in educating fellow professionals and the broader public about the brain effect of COVID-19, for example through ‘Five new papers in Five minutes’ update slots and the monthly Brain Infections Global webinars. I have also given lectures at the Royal College of Psychiatrists COVID-19 webinars as well as meetings for the liaison, forensic and neuropsychiatry faculties, the British Neuropsychiatry Faculty and international meetings such as at Massachusetts General Hospital and Harvard Medical School Behavioral Neurology and Neuropsychiatry Lecture series.
3. The CoroNerve surveillance study
Initially there were concerns that COVID-19 was potentially a highly neuro invasive virus. King’s Health Partners Neurosciences is involved in an ongoing national surveillance study looking at the neurology and psychiatry complications of COVID-19. This grew out of a surveillance study that was led from Liverpool.
The CoroNerve surveillance study is a based on an existing, dormant study that was set up and ready to implement for a pandemic of any description. It was designed before COVID-19 so that in the event of a pandemic, all the approvals were in place for it to start capturing data on neurological complications of any infectious outbreak and start running with no delays.
The study had originally relied on clinicians reporting patients’ neurological complications from COVID-19. The boundaries between neurology and psychiatry are quite blurred and it became clear there are a lot of psychiatric complications as well neurological. That is why the Institute joined the CoroNerve surveillance and bolted on a psychiatry arm. The surveillance portal allows clinicians to report the COVID-19 neuropsychiatric cases in a formal way, providing a national reporting system for new and emerging issues associated with COVID-19.
Read more about the paper published in the Lancet Psychiatry in June that gives details on the first 153 notifications of potential psychiatric and neurological complications and this preprint gives full clinical details on the 267 cases.
4. The COVID-19 Clinical Neuroscience Study
The COVID-19 Clinical Neuroscience Study (COVID-CNS) is linked to the CoroNerve surveillance study. It is funded by a UK Research and Innovation £2.8million grant. We at King’s College London co-led on the COVID-CNS study with the University of Liverpool. It is the largest UK and international study on the neurological and psychiatry impact of COVID-19.
The study looks at 800 UK patients who were admitted to hospital with COVID-19 and had neurological or neuropsychiatric complications. The aim is to understand how these problems occur and develop strategies to prevent and treat them.
5. Repeated Assessment of Mental health in Pandemics (RAMP) study
King’s Health Partners Neurosciences is also involved in the RAMP study that looks at the long-term impact of COVID-19 on mental health. Researchers look at contextual, psychological and behavioural factors that may affect risk and resilience to mental health problems during the pandemic. The questions assess symptoms of common mental health disorders, in both individuals with and without existing mental health problems. They also examine how life circumstances such as loneliness and employment, thought processes such as distracting oneself when worried, and self-care behaviours such as yoga or exercise, are affecting these symptoms.
6. The NHS CHECK study
King’s College London, with support from King's Health Partners, has also been conducting NHS CHECK. This is a large independent research study, supported by the NHS, to ensure all staff experiences are heard. All our NHS employees and contractors have been invited to join this study along with volunteers, fast-tracked or early qualified medical students, nursing students and other allied health profession students.
The study aims to evaluate any staff support programmes individuals may have accessed during the pandemic. This may include conducting virtual visits through projects such as Life Lines, which has been implemented in intensive care units across King's Health Partners and the UK.
Together, how does this research aim to improve outcomes for patients in south east London and beyond?
All of the research strands I have outlined are really about getting to grips with the nature and extent of neurological and psychiatric complications of COVID-19 so that in the long-term we can provide better care for patients in south east London and beyond.
As part of the national surveillance study, we are in the process of looking at what the neuropsychiatric problems of COVID-19 are. The next phase is the COVID-19 CNS study, which is looking at health mechanisms through interviews, blood tests, brain scans and trying to work out the causes affecting the brain. That research turn will inform management and treatment of patients.
Where do you think King’s Health Partners brings the most value for you and your team?
The opportunity to embed our research directly into clinical practice is where King’s Health Partners resonates strongly with me and the team. In all the leading studies I have mentioned, collaboration across the partnership has and continues to play an essential role. I admire the strength of King’s Health Partners Neurosciences expertise, particularly the overlap between neurology and psychiatry. It really does put us in a great position to lead in this area of research.
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