AbstractBackground and PurposeCoronavirus disease (COVID‐19) is still considered a global pandemic. The prognosis of COVID‐19 patients varies greatly. We aimed to assess the impact of preexisting, chronic neurological diseases (CNDs) and new‐onset acute neurological complications (ANCs) on the disease course, its complications, and outcomes.MethodsWe conducted a monocentric retrospective analysis from all hospitalized COVID‐19 patients between May 1, 2020 and January 31, 2021. Employing multivariable logistic regression models, we explored the association of CNDs and ANCs separately with hospital mortality and functional outcome.ResultsA total of 250 among 709 patients with COVID‐19 had CNDs. We found a 2.0 times higher chance of death (95% confidence interval [CI]: 1.37–2.92) for CND patients than for non‐CND patients. The chance for an unfavorable functional outcome (modified Rankin Scale > 3 at discharge) was 1.67 times higher in patients with CNDs than those without (95% CI: 1.07–2.59). Furthermore, 117 of all patients had 135 ANCs in total. We observed a 1.86 times higher chance to die (95% CI: 1.18–2.93) for patients with ANCs than without. The chance for a worse functional outcome was 3.6‐fold higher in ANC patients than without (95% CI: 2.22–6.01). Patients with CNDs had 1.73 times higher odds for developing ANCs (95% CI: 0.97–3.08).ConclusionPreexisting neurologic disorders or ANCs in COVID‐19 patients were associated with higher mortality and poorer functional outcome at discharge. Furthermore, development of acute neurologic complications was more frequent in patients with preexisting neurologic disease. Early neurological evaluation appears to be an important prognostic factor in COVID‐19 patients.