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@ARTICLE{Dadsena:281778,
      author       = {Dadsena, Ravi and Wetz, Sophie and Hofmann, Anna and Costa,
                      Ana Sofia and Romanzetti, Sandro and Lischewski, Stella
                      Andrea and Krockauer, Christina and Balloff, Carolin and
                      Binkofski, Ferdinand and Schulz, Jörg B and Reetz, Kathrin
                      and Walders, Julia},
      title        = {{E}vidence of clinical and brain recovery in
                      post-{COVID}-19 condition: a three-year follow-up study.},
      journal      = {Brain communications},
      volume       = {7},
      number       = {5},
      issn         = {2632-1297},
      address      = {[Oxford]},
      publisher    = {Oxford University Press},
      reportid     = {DZNE-2025-01173},
      pages        = {fcaf366},
      year         = {2025},
      abstract     = {Fatigue and cognitive dysfunction linked to persistent
                      brain changes have been reported for up to two years after
                      COVID-19. In this study, we followed the clinical,
                      neuroimaging and fluid biomarker trajectories over three
                      years post SARS-CoV-2 infection to evaluate potential signs
                      and underlying factors of brain recovery. We conducted a
                      monocentric, longitudinal study using resting-state
                      functional and structural T1-weighted magnetic resonance
                      imaging data from 51 patients with post-COVID-19 condition
                      (mean age 50 years, 33 female) collected at a mean time of
                      6, 23 and 38 months after COVID-19 infection. The trajectory
                      of brain changes was compared to 23 age- and sex-matched
                      healthy controls (mean age 37 years, 13 female) with similar
                      time intervals between brain scans and analysed in relation
                      to clinical, neuropsychological and fluid biomarkers
                      including interleukins and neurodestruction markers at all
                      timepoints. In addition, hand grip strength to evaluate
                      muscular fatigue was assessed at the final follow-up visit.
                      Self-reported fatigue improved over time but was still
                      moderate on average three years after COVID-19 infection,
                      while measures of hand grip strength and cognitive
                      performance were largely unaffected. We found a significant
                      increase of both lateral ventricles $(∼8\%)$ and the third
                      $(∼6\%)$ ventricle accompanied by a structural volume
                      reduction in adjacent areas including the thalamus,
                      pallidum, caudate nucleus and putamen. An increased neuronal
                      activation pattern was widespread and pronounced in these
                      areas. The brainstem no longer exhibited volume loss as
                      reported in our pervious study, but enhanced functional
                      connectivity. Laboratory markers including interleukins and
                      neuronal injury markers remained within the normal reference
                      ranges across all study timepoints. Our study revealed an
                      overall slow but evident clinical improvement, including
                      improved fatigue, regular muscular strength and recovery as
                      well as normal cognitive function without signs of systemic
                      inflammation three years after COVID-19. Clinical
                      improvement is reflected by a pattern of brain recovery
                      along periventricular regions. This pattern is characterized
                      by structural stabilization and increased connectivity
                      starting in the brainstem as well as efficient neuronal
                      recruitment and increased activation in the basal ganglia,
                      with no evidence of neuronal injury. These results highlight
                      the positive long-term recovery trajectory in post-COVID
                      patients.},
      keywords     = {ALFF (Other) / CNS (Other) / MRI (Other) / fatigue (Other)
                      / long COVID (Other)},
      cin          = {AG Jucker},
      ddc          = {610},
      cid          = {I:(DE-2719)1210001},
      pnm          = {352 - Disease Mechanisms (POF4-352)},
      pid          = {G:(DE-HGF)POF4-352},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41079753},
      pmc          = {pmc:PMC12508649},
      doi          = {10.1093/braincomms/fcaf366},
      url          = {https://pub.dzne.de/record/281778},
}