Functional brain alterations in COVID-19 patients using resting-state fMRI: a systematic review

This study systematically reviews the available evidence on resting-state functional magnetic resonance imaging (rs-fMRI) related to neurological symptoms and cognitive declines in COVID-19 patients. We followed PRISMA guidelines and looked up the PubMed, and Scopus databases for articles search on COVID-19 patients with neurological impairments, and functional connectivity alteration using rs-fMRI technique. Articles published between January 1, 2020, and May 31, 2024, are included in this study. The Quality Assessment Tool for Observational Prospective and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of papers. A total of 15 articles met the inclusion criteria. The result reveals that the most prevalent neurological impairment associated with COVID-19 was cognitive decline, encompassing issues in attention, memory, processing speed, executive functions, language, and visuospatial ability. The brain connectivity results reveal that two brain areas were functionally altered; the prefrontal cortex and parahippocampus. The functional connectivity mainly increased in the frontal, temporal, and anterior piriform cortex, and reduced in the cerebellum, superior orbitofrontal cortex, and middle temporal gyrus, which also correlated with cognitive decline. The findings of neurological symptoms indicate one study reported a Disorder of Consciousness (DoC), and four studies reported COVID-19 patients with olfactory dysfunction. The present study concludes that COVID-19 can alter brain functional connectivity and offers significant insight into how COVID-19 affects the neuronal foundation of cognitive decline and other neurological impairments.