Macro- and Microstructural White Matter Differences in Neurologic Postacute Sequelae of SARS-CoV-2 Infection

On the d2 Test of Attention between-group comparisons, NeuroPASC participants showed significantly: (A) lower processing speed (β = −0.30; 95% CI: −0.51–−0.09; t = −2.80), (B) concentration (β = −0.22; 95% CI: −0.43–−0.01; t = −2.09), and (C) accuracy (β = −0.27; 95% CI: −0.48–−0.06; t = −2.60).

The total intracranial tissue compartments show interrelated changes consistent with maintenance of constant intracranial volume for each participant. In NeuroPASC participants, cerebral global WM volume is significantly higher, GM is higher, and CSF is lower (left). A voxelwise map of WM volume revealed widespread, predominantly frontal and subcortical, higher regional WM volume in the NeuroPASC group (red-yellow; P = .005, by using TFCE FWE-correction (right).

In NeuroPASC participants, regional GM volume was higher in the prefrontal cortex. Voxelwise analysis of group differences in GM volume (red-yellow) are superimposed on the group mean T1-weighted structural images. Suprathreshold voxels that represent areas of higher GM volume in NeuroPASC compared with NoCOVID (P = .005, TFCE FWE-corrected) are shown in coronal slices with MNI coordinates and participant left on viewer left. The color bar shows T statistic values.

In NeuroPASC participants, WM mean kurtosis is significantly higher. A voxelwise analysis demonstrates group differences. Areas of higher mean kurtosis (red-yellow) superimposed on the DTI fractional anisotropy skeleton (blue) represent areas of higher WM mean kurtosis in NeuroPASC compared with NoCOVID (left) axial view, and (right) coronal view. The critical threshold was (P = .05, TFCE FWE-corrected).

Higher clinical PASC scores were associated with significantly lower processing speed (A: β = −0.30; 95% CI: −0.51–−0.09; t = −2.80), lower concentration (B: β = −0.22; 95% CI: −0.43–−0.01; t = −2.09), and fewer correct responses (C: β = −0.27; 95% CI: −0.48–−0.06; t = −2.60).