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Pre-Existing Neurological Conditions and COVID-19 Risk: A Commissioned Rapid Review

Background: Pre-existing diseases are considered risk factors for severe COVID-19 and death. However, there is lack of consolidated global data on this risk among individuals with pre-existing neurological disease. 
 
Aim: Investigate the impact of pre-existing neurological disease on the clinical course and outcome of COVID-19. 
 
Methods: A rapid review of literature from PubMed and the World Health Organization (WHO) COVID-19 database was conducted for articles published between 1st January 2020 and 4th April 2021. The review included individuals with COVID-19 and pre-existing neurological disease using pre-generated search terms to capture chronic neurological diseases in all age-groups. Articles included in the review were systematic reviews and meta-analysis, cohort studies, retrospective studies, case-control studies and case series. From the included studies, demographic data and Odds Ratios (OR) were extracted, and pooled ORs were generated for the outcomes of COVID-19 severity and death. 
 
Results: Twenty-six articles from 12 countries across three continents with a total of 379,947 COVID-19 patients was included. The mean age was 57 years (SD 10.93), 51.3% of whom were female. Pre-existing neurological disease, particularly cerebrovascular disease and dementia, was shown to be a risk factor for severe COVID-19 with a pooled OR of 1.99 (1.81 – 2.18). There was also an increased risk of death with a pooled OR for pre-existing neurological disease overall of 1.74 (1.56 – 1.94). 
 
Conclusion: The findings suggest that pre-existing neurological disease is a significant risk factor for severe COVID-19 and mortality. Further investigations to consolidate these findings are required through large multi-national cohort studies.