51
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Alves EV, Beber BC. Self-perception of cognitive sequels in post-COVID-19 individuals. Dement Neuropsychol 2023; 17:e20220080. [PMID: 37223832 PMCID: PMC10202328 DOI: 10.1590/1980-5764-dn-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 05/25/2023] Open
Abstract
COVID-19 is an infection, primarily respiratory, caused by the SARS-CoV-2, which can also affect the central nervous system, causing neuropsychological damage. There are studies describing post-COVID-19 cognitive deficits, but it is important to know this outcome in populations with different social, biological, and cultural characteristics. Objective The aim of this study was to assess the self-perception of cognitive sequelae in post-COVID-19 individuals and identify whether there is a possible relationship between the outcome of the participants' self-perception and sociodemographic and clinical data. Methods This is a cross-sectional study, carried out through an online questionnaire on the Google Forms platform, in which sociodemographic data, general health data, clinical manifestations of COVID-19, and post-COVID-19 self-perception of the cognitive domains of memory, attention, language, and executive functions were collected. Results The final sample consisted of 137 participants, and it was possible to identify that memory and attention were the domains with the highest impression of worsening post-COVID-19, followed by executive functions and language. In addition, it was identified that being female may be related to a worse self-perception of all cognitive functions and that having depression or other psychiatric diseases and obesity can significantly affect at least half of the cognitive domains evaluated. Conclusions This study pointed to a post-COVID-19 cognitive worsening of the participants.
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Affiliation(s)
- Emily Viega Alves
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil
| | - Bárbara Costa Beber
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil
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52
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Díez-Cirarda M, Yus M, Gómez-Ruiz N, Polidura C, Gil-Martínez L, Delgado-Alonso C, Jorquera M, Gómez-Pinedo U, Matias-Guiu J, Arrazola J, Matias-Guiu JA. Multimodal neuroimaging in post-COVID syndrome and correlation with cognition. Brain 2023; 146:2142-2152. [PMID: 36288544 PMCID: PMC9620345 DOI: 10.1093/brain/awac384] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/12/2022] Open
Abstract
Brain changes have been reported in the first weeks after SARS-CoV-2 infection. However, limited literature exists about brain alterations in post-COVID syndrome, a condition increasingly associated with cognitive impairment. The present study aimed to evaluate brain functional and structural alterations in patients with post-COVID syndrome, and assess whether these brain alterations were related to cognitive dysfunction. Eighty-six patients with post-COVID syndrome and 36 healthy controls were recruited and underwent neuroimaging acquisition and a comprehensive neuropsychological assessment. Cognitive and neuroimaging examinations were performed 11 months after the first symptoms of SARS-CoV-2. Whole-brain functional connectivity analysis was performed. Voxel-based morphometry was performed to evaluate grey matter volume, and diffusion tensor imaging was carried out to analyse white-matter alterations. Correlations between cognition and brain changes were conducted and Bonferroni corrected. Post-COVID syndrome patients presented with functional connectivity changes, characterized by hypoconnectivity between left and right parahippocampal areas, and between bilateral orbitofrontal and cerebellar areas compared to controls. These alterations were accompanied by reduced grey matter volume in cortical, limbic and cerebellar areas, and alterations in white matter axial and mean diffusivity. Grey matter volume loss showed significant associations with cognitive dysfunction. These cognitive and brain alterations were more pronounced in hospitalized patients compared to non-hospitalized patients. No associations with vaccination status were found. The present study shows persistent structural and functional brain abnormalities 11 months after the acute infection. These changes are associated with cognitive dysfunction and contribute to a better understanding of the pathophysiology of the post-COVID syndrome.
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Affiliation(s)
- María Díez-Cirarda
- Department of Neurology. Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Miguel Yus
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Natividad Gómez-Ruiz
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Carmen Polidura
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Lidia Gil-Martínez
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology. Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Manuela Jorquera
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Ulises Gómez-Pinedo
- Department of Neurology. Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology. Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Juan Arrazola
- Department of Radiology, Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology. Hospital Clínico San Carlos. Health Research Institute “San Carlos” (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
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53
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Jiang M, Jang SE, Zeng L. The Effects of Extrinsic and Intrinsic Factors on Neurogenesis. Cells 2023; 12:cells12091285. [PMID: 37174685 PMCID: PMC10177620 DOI: 10.3390/cells12091285] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
In the mammalian brain, neurogenesis is maintained throughout adulthood primarily in two typical niches, the subgranular zone (SGZ) of the dentate gyrus and the subventricular zone (SVZ) of the lateral ventricles and in other nonclassic neurogenic areas (e.g., the amygdala and striatum). During prenatal and early postnatal development, neural stem cells (NSCs) differentiate into neurons and migrate to appropriate areas such as the olfactory bulb where they integrate into existing neural networks; these phenomena constitute the multistep process of neurogenesis. Alterations in any of these processes impair neurogenesis and may even lead to brain dysfunction, including cognitive impairment and neurodegeneration. Here, we first summarize the main properties of mammalian neurogenic niches to describe the cellular and molecular mechanisms of neurogenesis. Accumulating evidence indicates that neurogenesis plays an integral role in neuronal plasticity in the brain and cognition in the postnatal period. Given that neurogenesis can be highly modulated by a number of extrinsic and intrinsic factors, we discuss the impact of extrinsic (e.g., alcohol) and intrinsic (e.g., hormones) modulators on neurogenesis. Additionally, we provide an overview of the contribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to persistent neurological sequelae such as neurodegeneration, neurogenic defects and accelerated neuronal cell death. Together, our review provides a link between extrinsic/intrinsic factors and neurogenesis and explains the possible mechanisms of abnormal neurogenesis underlying neurological disorders.
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Affiliation(s)
- Mei Jiang
- Department of Human Anatomy, Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Dongguan Campus, Guangdong Medical University, Dongguan 523808, China
| | - Se Eun Jang
- Neural Stem Cell Research Lab, Research Department, National Neuroscience Institute, Singapore 308433, Singapore
| | - Li Zeng
- Neural Stem Cell Research Lab, Research Department, National Neuroscience Institute, Singapore 308433, Singapore
- Neuroscience and Behavioral Disorders Program, DUKE-NUS Graduate Medical School, Singapore 169857, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technology University, Novena Campus, 11 Mandalay Road, Singapore 308232, Singapore
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54
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Ferrucci R, Cuffaro L, Capozza A, Rosci C, Maiorana N, Groppo E, Reitano MR, Poletti B, Ticozzi N, Tagliabue L, Silani V, Priori A. Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19. J Neurol 2023; 270:1823-1834. [PMID: 36692636 PMCID: PMC9873215 DOI: 10.1007/s00415-022-11543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023]
Abstract
Emerging evidence indicates that the etiologic agent responsible for coronavirus disease 2019 (COVID-19), can cause neurological complications. COVID-19 may induce cognitive impairment through multiple mechanisms. The aim of the present study was to describe the possible neuropsychological and metabolic neuroimaging consequences of COVID-19 12 months after patients' hospital discharge. We retrospectively recruited 7 patients (age [mean ± SD] = 56 years ± 12.39, 4 men) who had been hospitalized for COVID-19 with persistent neuropsychological deficits 12 months after hospital discharge. All patients underwent cognitive assessment and brain (18F-FDG) PET/CT, and one also underwent 18F-amyloid PET/CT. Of the seven patients studied, four had normal glucose metabolism in the brain. Three patients showed various brain hypometabolism patterns: (1) unilateral left temporal mesial area hypometabolism; (2) pontine involvement; and (3) bilateral prefrontal area abnormalities with asymmetric parietal impairment. The patient who showed the most widespread glucose hypometabolism in the brain underwent an 18F-amyloid PET/CT to assess the presence of Aβ plaques. This examination showed significant Aβ deposition in the superior and middle frontal cortex, and in the posterior cingulate cortex extending mildly in the rostral and caudal anterior cingulate areas. Although some other reports have already suggested that brain hypometabolism may be associated with cognitive impairment at shorter intervals from SarsCov-2 infection, our study is the first to assess cognitive functions, brain metabolic activity and in a patient also amyloid PET one year after COVID-19, demonstrating that cerebral effects of COVID-19 can largely outlast the acute phase of the disease and even be followed by amyloid deposition.
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Affiliation(s)
- Roberta Ferrucci
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Luca Cuffaro
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Antonella Capozza
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Chiara Rosci
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Natale Maiorana
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy
| | | | | | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Tagliabue
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alberto Priori
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy.
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy.
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55
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Ariza M, Cano N, Segura B, Adan A, Bargalló N, Caldú X, Campabadal A, Jurado MA, Mataró M, Pueyo R, Sala-Llonch R, Barrué C, Bejar J, Cortés CU, Garolera M, Junqué C. COVID-19 severity is related to poor executive function in people with post-COVID conditions. J Neurol 2023; 270:2392-2408. [PMID: 36939932 PMCID: PMC10026205 DOI: 10.1007/s00415-023-11587-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 03/21/2023]
Abstract
Patients with post-coronavirus disease 2019 (COVID-19) conditions typically experience cognitive problems. Some studies have linked COVID-19 severity with long-term cognitive damage, while others did not observe such associations. This discrepancy can be attributed to methodological and sample variations. We aimed to clarify the relationship between COVID-19 severity and long-term cognitive outcomes and determine whether the initial symptomatology can predict long-term cognitive problems. Cognitive evaluations were performed on 109 healthy controls and 319 post-COVID individuals categorized into three groups according to the WHO clinical progression scale: severe-critical (n = 77), moderate-hospitalized (n = 73), and outpatients (n = 169). Principal component analysis was used to identify factors associated with symptoms in the acute-phase and cognitive domains. Analyses of variance and regression linear models were used to study intergroup differences and the relationship between initial symptomatology and long-term cognitive problems. The severe-critical group performed significantly worse than the control group in general cognition (Montreal Cognitive Assessment), executive function (Digit symbol, Trail Making Test B, phonetic fluency), and social cognition (Reading the Mind in the Eyes test). Five components of symptoms emerged from the principal component analysis: the "Neurologic/Pain/Dermatologic" "Digestive/Headache", "Respiratory/Fever/Fatigue/Psychiatric" and "Smell/ Taste" components were predictors of Montreal Cognitive Assessment scores; the "Neurologic/Pain/Dermatologic" component predicted attention and working memory; the "Neurologic/Pain/Dermatologic" and "Respiratory/Fever/Fatigue/Psychiatric" components predicted verbal memory, and the "Respiratory/Fever/Fatigue/Psychiatric," "Neurologic/Pain/Dermatologic," and "Digestive/Headache" components predicted executive function. Patients with severe COVID-19 exhibited persistent deficits in executive function. Several initial symptoms were predictors of long-term sequelae, indicating the role of systemic inflammation and neuroinflammation in the acute-phase symptoms of COVID-19." Study Registration: www.ClinicalTrials.gov , identifier NCT05307549 and NCT05307575.
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Affiliation(s)
- Mar Ariza
- grid.5841.80000 0004 1937 0247Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.476208.f0000 0000 9840 9189Grup de Recerca en Cervell, Cognició I Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Neus Cano
- grid.5841.80000 0004 1937 0247Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- grid.476208.f0000 0000 9840 9189Grup de Recerca en Cervell, Cognició I Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- grid.410675.10000 0001 2325 3084Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Bàrbara Segura
- grid.5841.80000 0004 1937 0247Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ana Adan
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Psicologia Clínica I Psicobiologia, Universitat de Barcelona, Barcelona, Spain
| | - Núria Bargalló
- grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- grid.5841.80000 0004 1937 0247Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Xavier Caldú
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Psicologia Clínica I Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- grid.411160.30000 0001 0663 8628Institut de Recerca de Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Spain
| | - Anna Campabadal
- grid.5841.80000 0004 1937 0247Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Angeles Jurado
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Psicologia Clínica I Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- grid.411160.30000 0001 0663 8628Institut de Recerca de Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Spain
| | - Maria Mataró
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Psicologia Clínica I Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- grid.411160.30000 0001 0663 8628Institut de Recerca de Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Spain
| | - Roser Pueyo
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Psicologia Clínica I Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- grid.411160.30000 0001 0663 8628Institut de Recerca de Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Barcelona, Spain
| | - Roser Sala-Llonch
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- grid.5841.80000 0004 1937 0247Departament de Biomedicina, Universitat de Barcelona, Barcelona, Spain
- grid.429738.30000 0004 1763 291XCentro de Investigación Biomédica en Red en Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | | | - Javier Bejar
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Claudio Ulises Cortés
- grid.6835.80000 0004 1937 028XDepartament de Ciències de La Computació, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | | | - Maite Garolera
- grid.476208.f0000 0000 9840 9189Grup de Recerca en Cervell, Cognició I Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- grid.476208.f0000 0000 9840 9189Neuropsychology Unit, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Carme Junqué
- grid.5841.80000 0004 1937 0247Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- grid.5841.80000 0004 1937 0247Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
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56
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Asakawa T, Cai Q, Shen J, Zhang Y, Li Y, Chen P, Luo W, Zhang J, Zhou J, Zeng H, Weng R, Hu F, Feng H, Chen J, Huang J, Zhang X, Zhao Y, Fang L, Yang R, Huang J, Wang F, Liu Y, Lu H. Sequelae of long COVID, known and unknown: A review of updated information. Biosci Trends 2023; 17:85-116. [PMID: 36928222 DOI: 10.5582/bst.2023.01039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Over three years have passed since the COVID-19 pandemic started. The dangerousness and impact of COVID-19 should definitely not be ignored or underestimated. Other than the symptoms of acute infection, the long-term symptoms associated with SARS-CoV-2 infection, which are referred to here as "sequelae of long COVID (LC)", are also a conspicuous global public health concern. Although such sequelae were well-documented, the understanding of and insights regarding LC-related sequelae remain inadequate due to the limitations of previous studies (the follow-up, methodological flaws, heterogeneity among studies, etc.). Notably, robust evidence regarding diagnosis and treatment of certain LC sequelae remain insufficient and has been a stumbling block to better management of these patients. This awkward situation motivated us to conduct this review. Here, we comprehensively reviewed the updated information, particularly focusing on clinical issues. We attempt to provide the latest information regarding LC-related sequelae by systematically reviewing the involvement of main organ systems. We also propose paths for future exploration based on available knowledge and the authors' clinical experience. We believe that these take-home messages will be helpful to gain insights into LC and ultimately benefit clinical practice in treating LC-related sequelae.
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Affiliation(s)
- Tetsuya Asakawa
- Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qingxian Cai
- Department of Hepatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jiayin Shen
- Department of Science and Education, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Ying Zhang
- Department of Endocrinology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yongshuang Li
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Peifen Chen
- Department of Respiratory Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Wen Luo
- Department of Respiratory Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jiangguo Zhang
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jinfeng Zhou
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hui Zeng
- Department of Cardiology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Ruihui Weng
- Department of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Feng Hu
- Department of Nephrology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Huiquan Feng
- Department of Urology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jun Chen
- Department of Hepatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jie Huang
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xiaoyin Zhang
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yu Zhao
- Department of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Liekui Fang
- Department of Urology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Rongqing Yang
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jia Huang
- Department of Intensive Care Unit, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Fuxiang Wang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yingxia Liu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hongzhou Lu
- Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China.,Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
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57
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Schmidt J, Cruz M, Tolentino J, Carmo A, Paes M, de Lacerda G, Gjorup A, Schmidt S. COVID-19 Patients with Early Gastrointestinal Symptoms Show Persistent Deficits in Specific Attention Subdomains. J Clin Med 2023; 12:jcm12051931. [PMID: 36902717 PMCID: PMC10003448 DOI: 10.3390/jcm12051931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Previous studies have shown that COVID-19 inpatients exhibited significant attentional deficits on the day of discharge. However, the presence of gastrointestinal symptoms (GIS) has not been evaluated. Here, we aimed to verify: (1) whether COVID-19 patients with GIS exhibited specific attention deficits; (2) which attention subdomain deficits discriminated patients with GIS and without gastrointestinal symptoms (NGIS) from healthy controls. On admission, the presence of GIS was recorded. Seventy-four physically functional COVID-19 inpatients at discharge and sixty-eight controls underwent a Go/No-go computerized visual attentional test (CVAT). A Multivariate Analysis of Covariance (MANCOVA) was performed to examine group differences in attentional performance. To discriminate which attention subdomain deficits discriminated GIS and NGIS COVID-19 patients from healthy controls, a discriminant analysis was applied using the CVAT variables. The MANCOVA showed a significant overall effect of COVID-19 with GIS on attention performance. The discriminant analysis indicated that the GIS group could be differentiated from the controls by variability of reaction time and omissions errors. The NGIS group could be differentiated from controls by reaction time. Late attention deficits in COVID-19 patients with GIS may reflect a primary problem in the sustained and focused attention subsystems, whereas in NGIS patients the attention problems are related to the intrinsic-alertness subsystem.
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Affiliation(s)
- Juliana Schmidt
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Maria Cruz
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Julio Tolentino
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Aureo Carmo
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Maria Paes
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Glenda de Lacerda
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Ana Gjorup
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
| | - Sergio Schmidt
- Postgraduate Neurology Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 202709001, Brazil
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Voruz P, Cionca A, Jacot de Alcântara I, Nuber-Champier A, Allali G, Benzakour L, Lalive PH, Lövblad KO, Braillard O, Nehme M, Coen M, Serratrice J, Reny JL, Pugin J, Guessous I, Ptak R, Landis BN, Adler D, Griffa A, Van De Ville D, Assal F, Péron JA. Brain functional connectivity alterations associated with neuropsychological performance 6-9 months following SARS-CoV-2 infection. Hum Brain Mapp 2023; 44:1629-1646. [PMID: 36458984 PMCID: PMC9878070 DOI: 10.1002/hbm.26163] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypofunctional and hyperfunctional connectivities in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention, subcortical, and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory, executive functions performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological performance 6-9 months following SARS-CoV-2 infection. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to large-scale functional brain connectivity alterations.
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Affiliation(s)
- Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Cionca
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Isabele Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Nuber-Champier
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lamyae Benzakour
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Psychiatry Department, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice H Lalive
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karl O Lövblad
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Diagnostic and Interventional Neuroradiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mayssam Nehme
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Jacques Serratrice
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Jérôme Pugin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Radek Ptak
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Neurorehabilitation Department, Geneva University Hospitals, Geneva, Switzerland
| | - Basile N Landis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Rhinology-Olfactology Unit, Otorhinolaryngology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandra Griffa
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland.,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julie A Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland
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59
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Paolini M, Palladini M, Mazza MG, Colombo F, Vai B, Rovere-Querini P, Falini A, Poletti S, Benedetti F. Brain correlates of subjective cognitive complaints in COVID-19 survivors: A multimodal magnetic resonance imaging study. Eur Neuropsychopharmacol 2023; 68:1-10. [PMID: 36640728 PMCID: PMC9742225 DOI: 10.1016/j.euroneuro.2022.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Cognitive impairment represents a leading residual symptom of COVID-19 infection, which lasts for months after the virus clearance. Up-to-date scientific reports documented a wide spectrum of brain changes in COVID-19 survivors following the illness's resolution, mainly related to neurological and neuropsychiatric consequences. Preliminary insights suggest abnormal brain metabolism, microstructure, and functionality as neural under-layer of post-acute cognitive dysfunction. While previous works focused on brain correlates of impaired cognition as objectively assessed, herein we investigated long-term neural correlates of subjective cognitive decline in a sample of 58 COVID-19 survivors with a multimodal imaging approach. Diffusion Tensor Imaging (DTI) analyses revealed widespread white matter disruption in the sub-group of cognitive complainers compared to the non-complainer one, as indexed by increased axial, radial, and mean diffusivity in several commissural, projection and associative fibres. Likewise, the Multivoxel Pattern Connectivity analysis (MVPA) revealed highly discriminant patterns of functional connectivity in resting-state among the two groups in the right frontal pole and in the middle temporal gyrus, suggestive of inefficient dynamic modulation of frontal brain activity and possible metacognitive dysfunction at rest. Beyond COVID-19 actual pathophysiological brain processes, our findings point toward brain connectome disruption conceivably translating into clinical post-COVID cognitive symptomatology. Our results could pave the way for a potential brain signature of cognitive complaints experienced by COVID-19 survivors, possibly leading to identify early therapeutic targets and thus mitigating its detrimental long-term impact on quality of life in the post-COVID-19 stages.
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Affiliation(s)
- Marco Paolini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; PhD Program in Molecular Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Mariagrazia Palladini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy.
| | - Mario Gennaro Mazza
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Colombo
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| | - Benedetta Vai
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy; Division of Immunology, Transplantation and Infectious Diseases, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Andrea Falini
- Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroradiology, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Sara Poletti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Benedetti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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60
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Basagni B, Abbruzzese L, Damora A, Conforti J, Saviola D, De Tanti A, Podgorska A, Biagioni C, Bacci M, Gambarelli C, Strologo F, Maietti A, Mancuso M. Cognition in COVID-19 infected patients undergoing invasive ventilation: results from a multicenter retrospective study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 36827188 DOI: 10.1080/23279095.2023.2181083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A growing number of scientific contributions suggest that COVID-19 infection can lead to impairment of cognition, mainly in executive functions and memory domains, even in the absence of frank neurological pathologies.The primary objective of this retrospective study is to evaluate the frequency and type of inefficiencies in a selection of cognitive tests administered to a sample of subjects who, following infection, required invasive assisted ventilation and were admitted to rehabilitation wards for the treatment of functional impairment.Fifty-seven subjects were enrolled. The recruited patients undergone an assessment of verbal and visuospatial memory and executive functions, upon entry into the rehabilitation department, after discharge from intensive care. The following tests were administered: Rey Auditory Verbal Learning Test (AVLT) (immediate and delayed recall), Rey-Osterrieth Complex Figure Test (ROCFT) (copy and delayed recall), Stroop Color-Word Test, and Trail Making Test (TMT, A and B).Deficient scores, in beyond 25% of subjects, were found in the copy of the ROCFT (32.1% of subjects), and in the delayed recall of ROCFT (27.2%). Between 10 and 20% of patients presented an abnormal result in delayed recall of AVLT (16.07%), and Stroop Test (time, 15.6%, error, 11.5%). Less than 10% of the sample had abnormal performances on TMT (A, 3.5%, and B, 9.4%), and in AVLT immediate recall (8.9%). Correlations of the performances with age, sex, and education were also found.This paper highlights the high incidence of abnormal cognitive performances in this specific subpopulation of patients with COVID-19 infection.
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Affiliation(s)
| | | | - Alessio Damora
- CRT Clinica Riabilitazione Toscana, Montevarchi (AR), Italy
| | | | | | | | - Aleksandra Podgorska
- UOC Recupero e Rieducazione Funzionale-Area Grossetana, USL Toscana Sud-Est, Grosseto (GR), Italy
| | - Clarissa Biagioni
- UOC Recupero e Rieducazione Funzionale-Area Grossetana, USL Toscana Sud-Est, Grosseto (GR), Italy
| | - Marco Bacci
- UOC Recupero e Rieducazione Funzionale-Area Grossetana, USL Toscana Sud-Est, Grosseto (GR), Italy
| | - Carmen Gambarelli
- Ospedale Civile di Baggiovara- Struttura Complessa di Medicina Riabilitativa, Baggiovara (MO), Italy
| | - Francesca Strologo
- Ospedale Civile di Baggiovara- Struttura Complessa di Medicina Riabilitativa, Baggiovara (MO), Italy
| | - Alessandra Maietti
- Fondazione Poliambulanza - UO Riabilitazione Specialistica, Brescia (BS), Italy
| | - Mauro Mancuso
- CRT Clinica Riabilitazione Toscana, Montevarchi (AR), Italy
- UOC Recupero e Rieducazione Funzionale-Area Grossetana, USL Toscana Sud-Est, Grosseto (GR), Italy
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61
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Almeria M, Cejudo JC, Sanz-Santos J, Deus J, Krupinski J. Impact of COVID-19 infection on cognition and its association with neurological symptoms. Brain Behav 2023; 13:e2902. [PMID: 36811291 PMCID: PMC10097052 DOI: 10.1002/brb3.2902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To characterize the cognitive profile following COVID-19 infection and its possible association to clinical symptoms, emotional disturbance, biomarkers, and disease severity. METHODS This was a single-center cross-sectional cohort study. Subjects between 20- and 60-year old with confirmed COVID-19 infection were included. Evaluation was performed between April 2020 and July 2021. Patients with previous cognitive impairment and other neurological or severe psychiatric disorders were excluded. Demographic and laboratory data were extracted from the medical records. RESULTS Altogether 200 patients were included, 85 subjects were female (42.3%), and mean age was 49.12 years (SD: 7.84). Patients were classified into four groups: nonhospitalized (NH, n = 21), hospitalized without intensive care unit (ICU) nor oxygen therapy (HOSP, n = 42), hospitalized without ICU but with oxygen therapy (OXY, n = 107), and ICU (ICU, n = 31) patients. NH group was younger (p = .026). No significant differences were found in any test performed attending severity of illness (p > .05). A total of 55 patients reported subjective cognitive complaints (SCC). Subjects with neurological symptoms (NS) performed worse in trail making test B (p = .013), digits backwards (p = .006), letter&numbers (p = .002), symbol digit modalities test (p = .016), and Stroop color (p = .010) tests. CONCLUSIONS OXY patients and females referred more SCC associated with symptoms of anxiety and depression. Objective cognitive performance was unrelated to SCC. No cognitive impairment was found regarding the severity of COVID-19 infection. Results suggest that NS such as headache, anosmia, and dysgeusia during infection were a risk factor for later cognitive deficits. Tests assessing attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients.
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Affiliation(s)
- Marta Almeria
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Department of Neurology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Juan Carlos Cejudo
- Cognitive Impairment and Dementia Unit, Hospital Sagrat Cor, Hermanas Hospitalarias, Martorell, Barcelona, Spain
| | - Jose Sanz-Santos
- Department of Pneumology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Joan Deus
- Clinical and Health Department, Psychology Faculty, Autonomous University of Barcelona, Barcelona, Spain.,MRI Research Unit, Hospital del Mar, Barcelona, Spain
| | - Jerzy Krupinski
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Healthcare sciences Manchester Metropolitan University, CBS, Manchester, UK
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62
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Prabhakaran D, Day GS, Munipalli B, Rush BK, Pudalov L, Niazi SK, Brennan E, Powers HR, Durvasula R, Athreya A, Blackmon K. Neurophenotypes of COVID-19: risk factors and recovery outcomes. RESEARCH SQUARE 2023:rs.3.rs-2363210. [PMID: 36597538 PMCID: PMC9810229 DOI: 10.21203/rs.3.rs-2363210/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Coronavirus disease 2019 (COVID-19) infection is associated with risk of persistent neurocognitive and neuropsychiatric complications, termed "long COVID". It is unclear whether the neuropsychological manifestations of COVID-19 present as a uniform syndrome or as distinct neurophenotypes with differing risk factors and recovery outcomes. We examined post-acute neuropsychological profiles following SARS-CoV-2 infection in 205 patients recruited from inpatient and outpatient populations, using an unsupervised machine learning cluster analysis, with objective and subjective measures as input features. This resulted in three distinct post-COVID clusters. In the largest cluster (69%), cognitive functions were within normal limits, although mild subjective attention and memory complaints were reported. Vaccination was associated with membership in this "normal cognition" phenotype. Cognitive impairment was present in the remaining 31% of the sample but clustered into two differentially impaired groups. In 16% of participants, memory deficits, slowed processing speed, and fatigue were predominant. Risk factors for membership in the "memory-speed impaired" neurophenotype included anosmia and more severe COVID-19 infection. In the remaining 15% of participants, executive dysfunction was predominant. Risk factors for membership in this milder "dysexecutive" neurophenotype included disease-nonspecific factors such as neighborhood deprivation and obesity. Recovery outcomes at 6-month follow-up differed across neurophenotypes, with the normal cognition group showing improvement in verbal memory and psychomotor speed, the dysexecutive group showing improvement in cognitive flexibility, and the memory-speed impaired group showing no objective improvement and relatively worse functional outcomes compared to the other two clusters. These results indicate that there are multiple post-acute neurophenotypes of long COVID, with different etiological pathways and recovery outcomes. This information may inform phenotype-specific approaches to treatment.
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63
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Prabhakaran D, Day G, Munipalli B, Rush B, Pudalov L, Niazi S, Brennan E, Powers H, Durvasula R, Athreya A, Blackmon K. Neurophenotypes of COVID-19: risk factors and recovery outcomes. RESEARCH SQUARE 2023:rs.3.rs-2363210. [PMID: 36597538 PMCID: PMC9810229 DOI: 10.21203/rs.3.rs-2363210/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) infection is associated with risk of persistent neurocognitive and neuropsychiatric complications, termed "long COVID". It is unclear whether the neuropsychological manifestations of COVID-19 present as a uniform syndrome or as distinct neurophenotypes with differing risk factors and recovery outcomes. We examined post-acute neuropsychological profiles following SARS-CoV-2 infection in 205 patients recruited from inpatient and outpatient populations, using an unsupervised machine learning cluster analysis, with objective and subjective measures as input features. This resulted in three distinct post-COVID clusters. In the largest cluster (69%), cognitive functions were within normal limits, although mild subjective attention and memory complaints were reported. Vaccination was associated with membership in this "normal cognition" phenotype. Cognitive impairment was present in the remaining 31% of the sample but clustered into two differentially impaired groups. In 16% of participants, memory deficits, slowed processing speed, and fatigue were predominant. Risk factors for membership in the "memory-speed impaired" neurophenotype included anosmia and more severe COVID-19 infection. In the remaining 15% of participants, executive dysfunction was predominant. Risk factors for membership in this milder "dysexecutive" neurophenotype included disease-nonspecific factors such as neighborhood deprivation and obesity. Recovery outcomes at 6-month follow-up differed across neurophenotypes, with the normal cognition group showing improvement in verbal memory and psychomotor speed, the dysexecutive group showing improvement in cognitive flexibility, and the memory-speed impaired group showing no objective improvement and relatively worse functional outcomes compared to the other two clusters. These results indicate that there are multiple post-acute neurophenotypes of long COVID, with different etiological pathways and recovery outcomes. This information may inform phenotype-specific approaches to treatment.
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64
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De Tanti A, Conforti J, Bruni S, De Gaetano K, Cappalli A, Basagni B, Bertoni D, Saviola D. Cognitive and psychological outcomes and follow-up in severely affected COVID-19 survivors admitted to a rehabilitation hospital. Neurol Sci 2023; 44:1481-1489. [PMID: 36757605 PMCID: PMC9910237 DOI: 10.1007/s10072-023-06665-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) represents the most recent severe pandemic resulting in coronavirus disease 2019 (COVID-19). COVID-19 can damage the central nervous system, requiring admission to intensive care units (ICU) and aggressive treatments (long-term ventilatory assistance and sedation) to stabilize vitals. Most post-COVID-19 patients experience cognitive impairments and mood or stress disorders. We aimed to study the frequency of cognitive deficits in COVID-19 survivors, the relationship between clinical factors in the acute phase and cognitive outcomes, affective states, and quality of life. We explored cognitive reserve (CR) role, as a post-COVID-19 resilience factor. METHODS Twenty-nine COVID-19 inpatients were assessed using a neuropsychological battery, mood scales, quality of life, and social integration questionnaires. Twenty-five were retained through telephone follow-up to monitor cognitive sequelae, affective states, and reintegration levels roughly 8 months after hospital discharge. We administered the Cognitive Reserve Index questionnaire. RESULTS We found most patients display no cognitive deficits. When they did, multi-domain impairment occurred most frequently, especially involving executive functions. Results revealed a significant correlation between depression levels and the interval between ICU admission and tracheal tube removal. We found increased levels of depression and anxiety at follow-up, a significant relationship between resuming daily life activities, high CR, and executive functions. CONCLUSIONS These findings suggest the importance of psychological support in the long term and the modulating role of cognitive reserve in quality of life after infection.
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Affiliation(s)
- Antonio De Tanti
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
| | - Jessica Conforti
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
| | - Stefania Bruni
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
| | - Katia De Gaetano
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
| | - Asya Cappalli
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
| | | | - Debora Bertoni
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy.
| | - Donatella Saviola
- Centro Cardinal Ferrari, Via IV Novembre 21, Fontanellato, Parma, Italy
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65
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Llana T, Mendez M, Garces-Arilla S, Hidalgo V, Mendez-Lopez M, Juan MC. Association between olfactory dysfunction and mood disturbances with objective and subjective cognitive deficits in long-COVID. Front Psychol 2023; 14:1076743. [PMID: 36818111 PMCID: PMC9932904 DOI: 10.3389/fpsyg.2023.1076743] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background and purpose The coronavirus disease 2019 (COVID-19) has been associated with olfactory dysfunction. The persistent symptoms of anosmia or hyposmia were associated in previous studies with the development of memory impairment and mood disturbances. We aimed to investigate the association between the chronicity of reported olfactory dysfunction and subjective and objective cognitive performance in long-COVID patients and to explore whether their emotional symptoms are related to their cognition. Methods One hundred twenty-eight long-COVID participants were recruited. Reported symptomatology, subjective memory complaints, anxiety and depression symptomatology, and trait-anxiety were assessed. Subjective memory complaints and mood disturbances were compared among groups of participants with olfactory dysfunction as an acute (AOD), persistent (POD), or nonexistent (NOD) symptom. Seventy-six of the volunteers also participated in a face-to-face session to assess their objective performance on tests of general cognitive function and verbal declarative memory. Objective cognitive performance and mood disturbances were compared among the AOD, POD, and NOD groups. Results The subjective memory complaints and the anxiety and depression symptoms were similar among the groups, but the score in general cognitive function was lower in the participants with symptoms of acute olfactory dysfunction than in those with no olfactory symptoms at any time. Participants' memory complaints were positively related to their emotional symptoms. The relationship between depressive symptomatology and memory complaints interacted with the olfactory dysfunction, as it only occurred in the participants without symptoms of olfactory dysfunction. Depressive symptomatology and acute olfactory symptoms were negatively associated with general cognitive function and delayed memory performance. The months elapsed from diagnosis to assessment also predicted delayed memory performance. Anxious symptomatology was negatively associated with the immediate ability to recall verbal information in participants who did not present olfactory dysfunction in the acute phase of the infection. Conclusion Olfactory dysfunction in the acute phase of the infection by COVID-19 is related to cognitive deficits in objective tests, and mood disturbances are associated with self-reported and objective memory. These findings may contribute to further understanding the neuropsychological and emotional aspects of long-COVID.
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Affiliation(s)
- Tania Llana
- Department of Psychology, Faculty of Psychology, University of Oviedo, Oviedo, Spain
- Neuroscience Institute of Princedom of Asturias (INEUROPA), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario, Oviedo, Spain
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain
| | - Marta Mendez
- Department of Psychology, Faculty of Psychology, University of Oviedo, Oviedo, Spain
- Neuroscience Institute of Princedom of Asturias (INEUROPA), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario, Oviedo, Spain
| | - Sara Garces-Arilla
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- Laboratory of Social Cognitive Neuroscience, Department of Psychobiology, University of Valencia, Valencia, Spain
| | - Magdalena Mendez-Lopez
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- IIS Aragon, Zaragoza, Spain
| | - M.-Carmen Juan
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain
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Cognitive Deficits in the Acute Phase of COVID-19: A Review and Meta-Analysis. J Clin Med 2023; 12:jcm12030762. [PMID: 36769410 PMCID: PMC9917639 DOI: 10.3390/jcm12030762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
This meta-analysis was conducted to quantify the risk of patients exhibiting cognitive deficits in the acute phase of COVID-19 at the time of the first variants (i.e., before the vaccine) and quantify the potential vulnerability of older patients and those who experienced more severe respiratory symptoms. To this end, we searched the LitCovid and EMBASE platforms for articles, including preprints, and included all studies (n = 48) that featured a measurement of cognition, which encompassed 2233 cases of COVID-19. Of these, 28 studies reported scores on global cognitive efficiency scales administered in the acute phase of COVID-19 (up to 3 months after infection). We were able to perform a meta-analysis of proportions on 24 articles (Npatients = 943), and a logistic regression on 18 articles (Npatients = 518). The meta-analysis for proportion indicated that 52.31% of patients with COVID-19 exhibited cognitive deficits in the acute phase. This high percentage, however, has to be interpreted taking in consideration the fact that the majority of patients were hospitalized, and some presented neurological complications, such as encephalopathy. A bootstrap procedure with random resampling revealed that an age of 59 was the threshold at which one would be more prone to present cognitive deficits. However, the severity of respiratory symptoms did not influence the scores on a global cognitive efficiency scale. Overall, our results indicated that neuropsychological deficits were a major consequence of the acute phase of the first forms of COVID-19.
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Bompani N, Bertella L, Barbieri V, Scarabel L, Scarpina F, Perucca L, Rossi P. The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program. J Int Med Res 2023; 51:3000605221148435. [PMID: 36650909 PMCID: PMC9869216 DOI: 10.1177/03000605221148435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. METHODS In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. RESULTS Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. CONCLUSIONS The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.
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Affiliation(s)
- Nicole Bompani
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,IRCCS Istituto Auxologico Italiano, U.O. di Riabilitazione Neuromotoria di Auxologico ‘Capitanio’, Milan, Italy
| | - Laura Bertella
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,Laura Bertella, Clinica Hildebrand, Centro di Riabilitazione Brissago, Via Crodolo 18, 6614 Brissago, Switzerland.
| | | | - Luca Scarabel
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,Clinica di Riabilitazione dell’Ente Ospedaliero Cantonale, sede di Novaggio e sede di Fado, Switzerland
| | - Federica Scarpina
- ‘Rita Levi Montalcini’ Department of Neurosciences, University of Turin, Italy,IRCCS Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Laura Perucca
- IRCCS Istituto Auxologico Italiano, U.O. di Riabilitazione Neuromotoria di Auxologico ‘Capitanio’, Milan, Italy,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Paolo Rossi
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland
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Kirchberger I, Peilstöcker D, Warm TD, Linseisen J, Hyhlik-Dürr A, Meisinger C, Goßlau Y. Subjective and Objective Cognitive Impairments in Non-Hospitalized Persons 9 Months after SARS-CoV-2 Infection. Viruses 2023; 15:256. [PMID: 36680296 PMCID: PMC9865483 DOI: 10.3390/v15010256] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Studies on cognitive problems of persons with mild COVID-19 courses are still lacking. This study aimed to determine the frequency and associated factors of subjective and objective cognitive problems after COVID-19 in non-hospitalized persons. Study participants were examined at the University Hospital of Augsburg from 04/11/2020 to 26/05/2021. The Wechsler Adult Intelligence Scale (WAIS) IV digit span, Stroop Color and Word Test (SCWT), Regensburger verbal fluency test (RWT) and, subjective ratings of memory and concentration were applied. Of the 372 participants (mean age 46.8 ± 15.2 years, 54.3% women, median time after infection 9.1 months), 24.9% reported concentration and 21.9% memory problems. Overall, 55.6% of the participants had at least a mild negative alteration in any cognitive test. The strongest impairments were found regarding memory functions (41.1% mild alterations, 6.2% distinct impairments) and verbal fluency (12.4% mild alterations, 5.4% distinct impairments). SCWT showed negative alterations in no more than 3.0% of the participants. Level of school education, age, and depressiveness emerged as significantly related to the cognitive tests. The number of complaints and depressiveness were significantly associated with subjective memory and concentration problems. It is important to identify mild cognitive impairment in non-hospitalized COVID-19 patients early to offer them effective interventions.
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Affiliation(s)
- Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, LMU Munich, 81377 Munich, Germany
| | - Daniela Peilstöcker
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - Tobias D. Warm
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, LMU Munich, 81377 Munich, Germany
| | - Alexander Hyhlik-Dürr
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Christine Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - Yvonne Goßlau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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Diana L, Regazzoni R, Sozzi M, Piconi S, Borghesi L, Lazzaroni E, Basilico P, Aliprandi A, Bolognini N, Bonardi DR, Colombo D, Salmaggi A. Monitoring cognitive and psychological alterations in COVID-19 patients: A longitudinal neuropsychological study. J Neurol Sci 2023; 444:120511. [PMID: 36473347 PMCID: PMC9707027 DOI: 10.1016/j.jns.2022.120511] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND SARS-COV-2 infection has been associated to long-lasting neuropsychiatric sequelae, including cognitive deficits, that persist after one year. However, longitudinal monitoring has been scarcely performed. Here, in a sample of COVID-19 patients, we monitor cognitive, psychological and quality of life-related profiles up to 22 months from resolution of respiratory disease. METHODS Out of 657 COVID-19 patients screened at Manzoni Hospital (Lecco, Italy), 22 underwent neuropsychological testing because of subjective cognitive disturbances at 6 months, 16 months, and 22 months. Tests of memory, attention, and executive functions were administered, along with questionnaires for depressive and Post-traumatic stress disorder (PTSD) symptoms, psychological well-being and quality of life. Cross-sectional descriptives, correlational, as well as longitudinal analyses considering COVID19-severity were carried out. A preliminary comparison with a sample of obstructive sleep apneas patients was also performed. RESULTS Around 50% of COVID-19 patients presented with cognitive deficits at t0. The most affected domain was verbal memory. Pathological scores diminished over time, but a high rate of borderline scores was still observable. Longitudinal analyses highlighted improvements in verbal and non-verbal long term memory, as well as attention, and executive functioning. Depression and PTSD-related symptoms were present in 30% of patients. The latter decreased over time and were associated to attentional-executive performance. CONCLUSIONS Cognitive dysfunctions in COVID-19 patients may extend over 1 year, yet showing a significant recovery in several cases. Cognitive alterations are accompanied by a significant psychological distress. Many patients displaying borderline scores, especially those at higher risk of dementia, deserve clinical monitoring.
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Affiliation(s)
- Lorenzo Diana
- Neurology Unit, Ospedale "A. Manzoni", Lecco, Italy; Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Matteo Sozzi
- Neurology Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Stefania Piconi
- Infectious Diseases Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Luca Borghesi
- Infectious Diseases Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Elisa Lazzaroni
- Department of Mental Health, Ospedale "A. Manzoni", Lecco, Italy
| | | | | | - Nadia Bolognini
- Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Psychology and NeuroMI, University of Milano-Bicocca, Milan, Italy
| | - Daniela R Bonardi
- Respiratory Unit, IRCCS INRCA (Italian National Research Centre On Aging), Casatenovo, Italy
| | - Daniele Colombo
- Respiratory Unit, IRCCS INRCA (Italian National Research Centre On Aging), Casatenovo, Italy
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Saucier J, Jose C, Beroual Z, Al-Qadi M, Chartrand S, Libert E, Losier MC, Cooling K, Girouard G, Jbilou J, Chamard-Witkowski L. Cognitive inhibition deficit in long COVID-19: An exploratory study. Front Neurol 2023; 14:1125574. [PMID: 37122293 PMCID: PMC10140516 DOI: 10.3389/fneur.2023.1125574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objectives An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition. Methodology A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1-4, 5-8, 9-12, and 13-16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy. Results Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period. Discussion This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.
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Affiliation(s)
- Jacob Saucier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Caroline Jose
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Zaynab Beroual
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mohammad Al-Qadi
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Simon Chartrand
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Eméraldine Libert
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Marie-Claire Losier
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Kendra Cooling
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Gabriel Girouard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Jalila Jbilou
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- School of Psychology, Université de Moncton, Moncton, NB, Canada
| | - Ludivine Chamard-Witkowski
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
- *Correspondence: Ludivine Chamard-Witkowski,
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Akıncı B, Oğul ÖE, Hanoğlu L, Kulaç B, Ören D, Ulu O, Basançelebi B. Evaluation of cognitive functions in adult individuals with COVID-19. Neurol Sci 2023; 44:793-802. [PMID: 36574178 PMCID: PMC9793347 DOI: 10.1007/s10072-022-06562-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive deficits that are associated with coronavirus disease 2019 (COVID-19) and occur in the acute period are gaining importance. While most studies have focused on the elderly severely affected during acute infection, it remains unclear whether mild to moderate COVID-19 results in cognitive deficits in young patients. This study aims to evaluate the post-infection cognitive functions of young adults with mild to moderate symptoms of COVID-19. METHODS A total of 100 adults with similar age and educational background were included in the study. Half of those had been infected with COVID-19 in the last 60 days (N = 50), and the other half had not (N = 50). Global cognitive skills of the participants were evaluated through Montreal Cognitive Assessment Scale (MoCA) and Clock-Drawing Test; memory functions with Öktem Verbal Memory Processes Test (Ö-VMPT); attention span with Digit Span Test; executive functions with Fluency Tests, Stroop Test, and Trail Making Test; visual perceptual skills with Rey Osterrieth Complex Figure Test (ROCF); and neuropsychiatric status with Neuropsychiatric Inventory (NPI). Evaluations were performed in the experimental group for 21 to 60 days from the onset of the disease, and throughout the study, in the control group. RESULTS It was found that global cognitive skills, verbal memory, visual memory, executive function, and neuropsychiatric status were affected during COVID-19 (p < 0.05). CONCLUSION When the cases were analyzed according to disease severity, no relationship was found between cognitive deficits and disease severity.
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Affiliation(s)
- Büşra Akıncı
- Department of Physical Therapy and Rehabilitation, Medipol Mega University Hospital, Bagcilar, 34214, Istanbul, Turkey.
| | - Özden Erkan Oğul
- Department of Occupational Therapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Lütfü Hanoğlu
- Department of Neurology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Betül Kulaç
- Department of Physical Therapy and Rehabilitation, Medipol Mega University Hospital, Bagcilar, 34214 Istanbul, Turkey
| | - Damla Ören
- Department of Physical Therapy and Rehabilitation, Pendik Medipol University Hospital, Istanbul, Turkey
| | - Oğulcan Ulu
- Faculty of Science and Letters, Psychology, Beykent University, Istanbul, Turkey
| | - Berkan Basançelebi
- Department of Electroneurophysiology, Health Vocational School Istanbul Medipol University, Istanbul, Turkey
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Cognitive Deficits among Individuals Admitted to a Post-Acute Pneumological Rehabilitation Unit in Southern Italy after COVID-19 Infection. Brain Sci 2023; 13:brainsci13010084. [PMID: 36672066 PMCID: PMC9857316 DOI: 10.3390/brainsci13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 male, median age 67.5) consisted of patients who received non-invasive mechanical ventilation; Group-2 (n = 19; 16 male, median age 63) consisted of patients who received invasive mechanical ventilation. All patients underwent a neuropsychological assessment including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS) to evaluate the patients' cognition. Depression and anxiety were also measured at admission and discharge to rehabilitation. (3) Results: At admission, patients impaired at MMSE were 44% in Group-1 and 5% in Group-2, while patients impaired at FAB were 88% in Group-1 and 26% in Group-2. Wilcoxon's effect size revealed meaningful differences between groups for FAB, R-BANS global score, immediate and delayed memory, and attention-coding task, with Group-2 performing better than Group-1 across all measures. At discharge, 52% of the 25 patients re-assessed still had mild to moderate cognitive deficits, while 19% had depression and 35% had anxiety. (4) Conclusions: Patients who received oxygen therapy experienced higher levels of acute and chronic stress compared to those who benefitted from invasive mechanical ventilation. Despite patients showing a meaningful improvement at discharge, cognitive impairment persisted in a great number of patients; therefore, long-term neuropsychological follow-up and treatment for COVID-19 patients are recommended.
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73
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Multidomain cognitive impairment in non-hospitalized patients with the post-COVID-19 syndrome: results from a prospective monocentric cohort. J Neurol 2023; 270:1215-1223. [PMID: 36422669 PMCID: PMC9686246 DOI: 10.1007/s00415-022-11444-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A fraction of patients with asymptomatic to mild/moderate acute COVID-19 disease report cognitive deficits as part of the post-COVID-19 syndrome. This study aimed to assess the neuropsychological profile of these patients. METHODS Assessment at baseline (three months or more following acute COVID-19) of a monocentric prospective cohort of patients with post-COVID-19 syndrome. Multidomain neuropsychological tests were performed, and questionnaires on depression, anxiety, fatigue, sleep, and general health status were administered. RESULTS Of the 58 patients screened, six were excluded due to possible alternative causes of cognitive impairment (major depression, neurodegenerative disease). Of the remaining 52 individuals, only one had a below-threshold screening result on Mini-Mental State Examination, and 13 scored below the cut-off on Montreal Cognitive Assessment. Extended neuropsychological testing revealed a neurocognitive disorder (NCD) in 31 (59.6%) participants with minor NCD in the majority of cases (n = 26). In patients with NCD, the cognitive domains learning/memory and executive functions were impaired in 60.7%, complex attention in 51.6%, language in 35.5%, and perceptual-motor function in 29.0%. Cognitive profiles were associated with daytime sleepiness but not with depression, anxiety, sleep quality, total general health status, or fatigue. CONCLUSION Neurocognitive impairment can be confirmed in around 60% of individuals with self-reported deficits as part of post-COVID-19 syndrome following a mild acute COVID-19 disease course. Notably, screening tests cannot reliably detect this dysfunction. Standard psychiatric assessments showed no association with cognitive profiles. Longitudinal studies are needed to further evaluate the course of neurocognitive deficits and clarify pathophysiology.
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Predominance of visuoconstructive impairment after mild COVID-19? Mol Psychiatry 2023; 28:536-537. [PMID: 36123422 PMCID: PMC9483875 DOI: 10.1038/s41380-022-01797-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
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Perrottelli A, Sansone N, Giordano GM, Caporusso E, Giuliani L, Melillo A, Pezzella P, Bucci P, Mucci A, Galderisi S. Cognitive Impairment after Post-Acute COVID-19 Infection: A Systematic Review of the Literature. J Pers Med 2022; 12:jpm12122070. [PMID: 36556290 PMCID: PMC9781311 DOI: 10.3390/jpm12122070] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The present study aims to provide a critical overview of the literature on the relationships between post-acute COVID-19 infection and cognitive impairment, highlighting the limitations and confounding factors. A systematic search of articles published from 1 January 2020 to 1 July 2022 was performed in PubMed/Medline. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies using validated instruments for the assessment of cognitive impairment were included. Out of 5515 screened records, 72 studies met the inclusion criteria. The available evidence revealed the presence of impairment in executive functions, speed of processing, attention and memory in subjects recovered from COVID-19. However, several limitations of the literature reviewed should be highlighted: most studies were performed on small samples, not stratified by severity of disease and age, used as a cross-sectional or a short-term longitudinal design and provided a limited assessment of the different cognitive domains. Few studies investigated the neurobiological correlates of cognitive deficits in individuals recovered from COVID-19. Further studies with an adequate methodological design are needed for an in-depth characterization of cognitive impairment in individuals recovered from COVID-19.
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76
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Nuber-Champier A, Voruz P, Jacot de Alcântara I, Breville G, Allali G, Lalive P, Assal F, Péron J. Monocytosis in the acute phase of SARS-CoV-2 infection predicts the presence of anosognosia for cognitive deficits in the chronic phase. Brain Behav Immun Health 2022; 26:100511. [PMID: 36128057 PMCID: PMC9477785 DOI: 10.1016/j.bbih.2022.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/22/2022] [Accepted: 09/11/2022] [Indexed: 12/01/2022] Open
Abstract
Reduced awareness of neuropsychological disorders (i.e., anosognosia) is a striking symptom of post-COVID-19 condition. Some leukocyte markers in the acute phase may predict the presence of anosognosia in the chronic phase, but they have not yet been identified. This study aimed to determine whether patients with anosognosia for their memory deficits in the chronic phase presented specific leukocyte distribution in the acute phase, and if so, whether these leukocyte levels might be predictive of anosognosia. First, we compared the acute immunological data (i.e., white blood cell differentiation count) of 20 patients who displayed anosognosia 6–9 months after being infected with SARS-CoV-2 (230.25 ± 46.65 days) versus 41 patients infected with SARS-Cov-2 who did not develop anosognosia. Second, we performed an ROC analysis to evaluate the predictive value of the leukocyte markers that emerged from this comparison. Blood circulating monocytes (%) in the acute phase of SARS-CoV-2 infection were associated with long-term post-COVID-19 anosognosia. A monocyte percentage of 7.35% of the total number of leukocytes at admission seemed to predict the presence of chronic anosognosia 6–9 months after infection.
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Affiliation(s)
- A. Nuber-Champier
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
- Neurology Division, Geneva University Hospitals, Switzerland
| | - P. Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
- Neurology Division, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - I. Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
- Neurology Division, Geneva University Hospitals, Switzerland
| | - G. Breville
- Neurology Division, Geneva University Hospitals, Switzerland
| | - G. Allali
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Switzerland
| | - P.H. Lalive
- Neurology Division, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - F. Assal
- Neurology Division, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - J.A. Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
- Neurology Division, Geneva University Hospitals, Switzerland
- Corresponding author. Faculté de Psychologie et des Sciences de l'Education, 40 bd du Pont d’Arve, 1205, Geneva, Switzerland.
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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78
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Nouraeinejad A. Brain fog as a Long-term Sequela of COVID-19. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:9. [PMID: 36466122 PMCID: PMC9685075 DOI: 10.1007/s42399-022-01352-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 05/31/2023]
Abstract
Increasing data indicate that people infected with COVID-19 are at high risk for developing long-term neurological complications, such as "brain fog" or cognitive impairment. However, little is known about the long-term outcomes of COVID-19 survivors. This also applies to the prevalence, risk factors, and pathobiological findings associated with these consequences. Although cognitive complications are anticipated in patients who require a long-lasting hospital stay or intubation, milder cases of COVID-19 with no record of hospitalization have also been shown to experience assessable cognitive challenges. Cognitive impairment can have a devastating impact on daily functioning. Understanding the long-term effect of COVID-19 on cognitive function is vital for applying specific schemes to those who wish to return to their jobs productively.
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Affiliation(s)
- Ali Nouraeinejad
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London (UCL), London, UK
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De Luca R, Bonanno M, Calabrò RS. Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach. J Clin Med 2022; 11:jcm11216554. [PMID: 36362782 PMCID: PMC9653636 DOI: 10.3390/jcm11216554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Long COVID is a clinical syndrome characterized by profound fatigue, neurocognitive difficulties, muscle pain, weakness, and depression, lasting beyond the 3–12 weeks following infection with SARS-CoV-2. Among the symptoms, neurocognitive and psychiatric sequelae, including attention and memory alterations, as well as anxiety and depression symptoms, have become major targets of current healthcare providers given the significant public health impact. In this context, assessment tools play a crucial role in the early screening of cognitive alterations due to Long COVID. Among others, the general cognitive assessment tools, such as the Montreal Cognitive assessment, and more specific ones, including the State Trait Inventory of Cognitive Fatigue and the Digit Span, may be of help in investigating the main neurocognitive alterations. Moreover, appropriate neurorehabilitative programs using specific methods and techniques (conventional and/or advanced) through a multidisciplinary team are required to treat COVID-19-related cognitive and behavioral abnormalities. In this narrative review, we sought to describe the main neurocognitive and psychiatric symptoms as well as to provide some clinical advice for the assessment and treatment of Long COVID.
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Newhouse A, Kritzer MD, Eryilmaz H, Praschan N, Camprodon JA, Fricchione G, Chemali Z. Neurocircuitry Hypothesis and Clinical Experience in Treating Neuropsychiatric Symptoms of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2. J Acad Consult Liaison Psychiatry 2022; 63:619-627. [PMID: 36030055 PMCID: PMC9404079 DOI: 10.1016/j.jaclp.2022.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Persistent symptoms following COVID-19 infection have been termed postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. Many of these symptoms are neuropsychiatric, such as inattention, impaired memory, and executive dysfunction; these are often colloquially termed "brain fog". These symptoms are common and often persist long after the acute phase. The pattern of these deficits combined with laboratory, neuroimaging, electroencephalographic, and neuropsychological data suggest that these symptoms may be driven by direct and indirect damage to the frontal-subcortical neural networks. Here, we review this evidence, share our clinical experience at an academic medical center, and discuss potential treatment implications. While the exact etiology remains unknown, a neurocircuit-informed understanding of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection can help guide pharmacology, neuromodulation, and physical and psychological therapeutic approaches.
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Affiliation(s)
- Amy Newhouse
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hamdi Eryilmaz
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nathan Praschan
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Zeina Chemali
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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81
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Albu S, Rivas Zozaya N, Murillo N, García-Molina A, Figueroa Chacón CA, Kumru H. Multidisciplinary outpatient rehabilitation of physical and neurological sequelae and persistent symptoms of covid-19: a prospective, observational cohort study. Disabil Rehabil 2022; 44:6833-6840. [PMID: 34559592 DOI: 10.1080/09638288.2021.1977398] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This prospective, observational cohort study investigated the effects of multidisciplinary rehabilitation of post Covid-19 sequelae and persistent symptoms and their impact on patients' functioning and quality of life. METHODS From 58 patients referred for neurorehabilitation, 43 were eligible for and participated in the present study. Before and after 8 weeks of rehabilitation, patients underwent physical, neuropsychological and respiratory evaluations and assessment of functional independence, impact of fatigue and quality of life. RESULTS Forty of 43 individuals (52 ± 11.4 years, 24 male) completed the rehabilitation program. Fatigue (87.5%), dyspnea and/or shortness of breath (62.5%), and cognitive impairment (37.5%) were reported by both previously hospitalized and home-confined patients. Neurological sequelae (35.5%) were present only in hospitalized patients. After 8 weeks of rehabilitation, patients reported significant improvements in motor functional independence, upper and lower limb functionality, impact of fatigue on daily activities, respiratory muscle strength, cognitive performance, and quality of life. CONCLUSIONS Post Covid-19 patients present with heterogeneous neurological, physical, and respiratory impairments requiring a multidisciplinary rehabilitation approach to reduce disability and improve functionality and quality of life. A comprehensive assessment of clinical profiles and responses to rehabilitation may facilitate the identification of rehabilitation candidates and help to design effective rehabilitation interventions.Implication for rehabilitationPost Covid-19 patients present multiple, heterogeneous neurological, physical and respiratory impairments that are observed in both previously hospitalized and home-confined patients.Eight weeks of multidisciplinary rehabilitation may significantly reduce disability and improve functionality and quality of life.A comprehensive assessment of their clinical profile and response to rehabilitation may facilitate the identification of rehabilitation candidates and help to design more effective rehabilitation interventions.
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Affiliation(s)
- Sergiu Albu
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Nicolás Rivas Zozaya
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Narda Murillo
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Alberto García-Molina
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Cristian Andrés Figueroa Chacón
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Hatice Kumru
- Fundació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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82
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de Graaf DM, Teufel LU, de Nooijer AH, van Gammeren AJ, Ermens AAM, Gaál IO, Crișan TO, van de Veerdonk FL, Netea MG, Dinarello CA, Joosten LAB, Arts RJW. Exploratory analysis of interleukin-38 in hospitalized COVID-19 patients. Immun Inflamm Dis 2022; 10:e712. [PMID: 36301025 PMCID: PMC9601778 DOI: 10.1002/iid3.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A major contributor to coronavirus disease 2019 (COVID-19) progression and severity is a dysregulated innate and adaptive immune response. Interleukin-38 (IL-38) is an IL-1 family member with broad anti-inflammatory properties, but thus far little is known about its role in viral infections. Recent studies have shown inconsistent results, as one study finding an increase in circulating IL-38 in COVID-19 patients in comparison to healthy controls, whereas two other studies report no differences in IL-38 concentrations. METHODS Here, we present an exploratory, retrospective cohort study of circulating IL-38 concentrations in hospitalized COVID-19 patients admitted to two Dutch hospitals (discovery n = 148 and validation n = 184) and age- and sex-matched healthy subjects. Plasma IL-38 concentrations were measured by enzyme-linked immunosorbent assay, disease-related proteins by proximity extension assay, and clinical data were retrieved from hospital records. RESULTS IL-38 concentrations were stable during hospitalization and similar to those of healthy control subjects. IL-38 was not associated with rates of intensive care unit admission or mortality. Only in men in the discovery cohort, IL-38 concentrations were positively correlated with hospitalization duration. A positive correlation between IL-38 and the inflammatory biomarker d-dimer was observed in men of the validation cohort. In women of the validation cohort, IL-38 concentrations correlated negatively with thrombocyte numbers. Furthermore, plasma IL-38 concentrations in the validation cohort correlated positively with TNF, TNFRSF9, IL-10Ra, neurotrophil 3, polymeric immunoglobulin receptor, CHL1, CD244, superoxide dismutase 2, and fatty acid binding protein 2, and negatively with SERPINA12 and cartilage oligomeric matrix protein. CONCLUSIONS These data indicate that IL-38 is not associated with disease outcomes in hospitalized COVID-19 patients. However, moderate correlations between IL-38 concentrations and biomarkers of disease were identified in one of two cohorts. While we demonstrate that IL-38 concentrations are not indicative of COVID-19 severity, its anti-inflammatory effects may reduce COVID-19 severity and should be experimentally investigated.
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Affiliation(s)
- Dennis M. de Graaf
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands,Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Lisa U. Teufel
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
| | - Aline H. de Nooijer
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
| | | | | | - Ildikó O. Gaál
- Department of Medical GeneticsIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Tania O. Crișan
- Department of Medical GeneticsIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Frank L. van de Veerdonk
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands,Department of Immunology and Metabolism, Life and Medical Sciences InstituteUniversity of BonnBonnGermany
| | - Charles A. Dinarello
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands,Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands,Department of Medical GeneticsIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Rob J. W. Arts
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboudumc Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
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83
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Ariza M, Cano N, Segura B, Adan A, Bargalló N, Caldú X, Campabadal A, Jurado MA, Mataró M, Pueyo R, Sala-Llonch R, Barrué C, Bejar J, Cortés CU, Junqué C, Garolera M. Neuropsychological impairment in post-COVID condition individuals with and without cognitive complaints. Front Aging Neurosci 2022; 14:1029842. [PMID: 36337708 PMCID: PMC9631485 DOI: 10.3389/fnagi.2022.1029842] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 07/22/2023] Open
Abstract
UNLABELLED One of the most prevalent symptoms of post-COVID condition is cognitive impairment, which results in a significant degree of disability and low quality of life. In studies with large sample sizes, attention, memory, and executive function were reported as long-term cognitive symptoms. This study aims to describe cognitive dysfunction in large post-COVID condition individuals, compare objective neuropsychological performance in those post-COVID condition individuals with and without cognitive complaints, and identify short cognitive exams that can differentiate individuals with post-COVID symptoms from controls. To address these aims, the Nautilus project was started in June 2021. During the first year, we collected 428 participants' data, including 319 post-COVID and 109 healthy controls (18-65 years old) from those who underwent a comprehensive neuropsychological battery for cognitive assessment. Scores on tests assessing global cognition, learning and long-term memory, processing speed, language and executive functions were significantly worse in the post-COVID condition group than in healthy controls. Montreal Cognitive Assessment, digit symbol test, and phonetic verbal fluency were significant in the binomial logistic regression model and could effectively distinguish patients from controls with good overall sensitivity and accuracy. Neuropsychological test results did not differ between those with and without cognitive complaints. Our research suggests that patients with post-COVID conditions experience significant cognitive impairment and that routine tests like the Montreal Cognitive Assessment, digit symbol, and phonetic verbal fluency test might identify cognitive impairment. Thus, the administration of these tests would be helpful for all patients with post-COVID-19 symptoms, regardless of whether cognitive complaints are present or absent. STUDY REGISTRATION www.ClinicalTrials.gov, identifiers NCT05307549 and NCT05307575.
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Affiliation(s)
- Mar Ariza
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Neus Cano
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Bàrbara Segura
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ana Adan
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Núria Bargalló
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Diagnostic Imaging Centre, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Xavier Caldú
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Anna Campabadal
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Angeles Jurado
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Maria Mataró
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Roser Pueyo
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Roser Sala-Llonch
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Biomedicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Cristian Barrué
- Department of Computer Science, Universitat Politècnica de Catalunya – BarcelonaTech, Barcelona, Spain
| | - Javier Bejar
- Department of Computer Science, Universitat Politècnica de Catalunya – BarcelonaTech, Barcelona, Spain
| | - Claudio Ulises Cortés
- Department of Computer Science, Universitat Politècnica de Catalunya – BarcelonaTech, Barcelona, Spain
| | - NAUTILUS-Project Collaborative GroupArauzoVanesaBerniaJose A.Balague-MarmañaMartaValles-PaulsBertaCaballeroJesúsCarnes-VendrellAnnaPiñol-RipollGerardGonzalez-AguadoEsterTayó-JuliCarmeForcadell-FerreresEvaReverte-VilarroyaSilviaFornéSusannaBartes-PlanAnnaMuñoz-PadrosJordinaMuñoz-MorenoJose A.Prats-ParisAnnaRicoInmaculadaSabéNuriaAlmeriaMartaCasasLauraCiudadMaria JoséFerréAnnaGarzonTamarLozanoManuelaCullellMartaVegaSoniaAlsinaSílviaMaldonado-BelmonteMaria J.Vazquez-RiveraSusanaBaillèsEvaNavarroSandraConsorci Sanitari de Terrassa (CST), Terrassa, Spain. Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral. Hospital Universitari Arnau de Vilanova, Lleida, Spain. Hospital Universitari de Santa Maria, Lleida, Spain. Consorci Sanitari Alt Penedès-Garraf, Vilafranca de Penedés, Barcelona, Spain. Hospital Verge de la Cinta, Tortosa, Tarragona, Spain. Fundació Sant Hospital de la Seu d’Urgell, La Seu d’Urgell, Lleida, Spain. Consorci Hospitalari de Vic, Vic, Barcelona, Spain. Servei de Malalties Infeccioses, Fundació Lluita contra les Infeccions – Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain. Badalona Serveis Assistencials, Badalona, Barcelona, Spain. Institut d’Assistència Sanitària, Girona, Spain. Fundació Salut Empordà, Figueres, Girona, Spain. Fundació Hospital de Puigcerdà, Puigcerdà, Girona, Spain. Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, Spain. Servei Andorrà d’Atenció Sanitària (SAAS), Andorra.
| | - Carme Junqué
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Maite Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Neuropsychology Unit, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
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84
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Gutierrez-Martinez L, Karten J, Kritzer MD, Josephy-Hernandez S, Kim D, Newhouse A, Pasinski M, Praschan N, Razafsha M, Rubin DB, Sonni A, Fricchione G, Rosand MPHJ, Chemali Z. Post-Acute Sequelae of SARS-CoV-2 Infection: A Descriptive Clinical Study. J Neuropsychiatry Clin Neurosci 2022; 34:393-405. [PMID: 35686346 DOI: 10.1176/appi.neuropsych.21070193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The investigators aimed to describe the clinical experience of a single center reporting on neuropsychiatric findings among patients experiencing persistent symptoms as part of post-acute sequelae of SARS-CoV-2 (PASC) infection. METHODS Data were collected retrospectively (between February 2020 and May 2021) from a cohort (N=100) within a COVID-19 survivors study of patients with persistent symptoms enrolled after a short inpatient stay or who had been outpatients never hospitalized. Patients without confirmatory positive PCR or antibody diagnostic test results were grouped separately as presumptive cases (N=13). RESULTS Of the 87 patients with confirmed SARS-CoV-2, 63 (72.4%) were female, and 65 (74.7%) were White. The mean age was 49.2 years (SD=14.9). The most prevalent symptoms after COVID-19 infection were fatigue, "brain fog," headache, anxiety, and sleep issues. Attention and executive function were frequently impaired. The mean Montreal Cognitive Assessment score was 26.0 (SD=2.8). Concentration and attention as well as memory issues were both significantly correlated with the complaint of brain fog. CONCLUSIONS These preliminary findings suggest that post-acute sequelae of SARS-CoV-2 vary in frequency and duration with relation to premorbid history and that these conditions affect functional domains and patients' ability to return to work. Longitudinal research with larger cohorts is needed to characterize PASC and to optimize care, especially for vulnerable populations.
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Affiliation(s)
- Leidys Gutierrez-Martinez
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Jordan Karten
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Michael D Kritzer
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Sylvia Josephy-Hernandez
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - David Kim
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Amy Newhouse
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Marie Pasinski
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Nathan Praschan
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Mahdi Razafsha
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Daniel B Rubin
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Akshata Sonni
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Gregory Fricchione
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - M P H Jonathan Rosand
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
| | - Zeina Chemali
- Henry and Allison McCance Center for Brain Health (Gutierrez-Martinez, Karten, Newhouse, Pasinski, Rubin, Sonni, Fricchione, Rosand, Chemali); Department of Psychiatry, Division of Neuropsychiatry (Kritzer, Josephy-Hernandez, Kim, Newhouse, Praschan, Razafsha, Fricchione, Chemali); Department of Neurology (Josephy-Hernandez, Kim, Pasinski, Rubin, Rosand, Chemali); Department of Medicine (Newhouse); and Benson-Henry Mind-Body Institute (Fricchione), Massachusetts General Hospital, Boston
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85
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Chen AK, Wang X, McCluskey LP, Morgan JC, Switzer JA, Mehta R, Tingen M, Su S, Harris RA, Hess DC, Rutkowski EK. Neuropsychiatric sequelae of long COVID-19: Pilot results from the COVID-19 neurological and molecular prospective cohort study in Georgia, USA. Brain Behav Immun Health 2022; 24:100491. [PMID: 35873350 PMCID: PMC9290328 DOI: 10.1016/j.bbih.2022.100491] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background As the coronavirus disease 2019 (COVID-19) pandemic continues, there has been a growing interest in the chronic sequelae of COVID-19. Neuropsychiatric symptoms are observed in the acute phase of infection, but there is a need for accurate characterization of how these symptoms evolve over time. Additionally, African American populations have been disproportionately affected by the COVID-19 pandemic. The COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia (CONGA) was established to investigate the severity and chronicity of these neurologic findings over the five-year period following infection. Methods The CONGA study aims to recruit COVID-19 positive adult patients in Georgia, United States from both the inpatient and outpatient setting, with 50% being African American. This paper reports our preliminary results from the baseline visits of the first 200 patients recruited who were on average 125 days since having a positive COVID-19 test. The demographics, self-reported symptoms, comorbidities, and quantitative measures of depression, anxiety, smell, taste, and cognition were analyzed. Cognitive measures were compared to demographically matched controls. Blood and mononuclear cells were drawn and stored for future analysis. Results Fatigue was the most reported symptom in the study cohort (68.5%). Thirty percent of participants demonstrated hyposmia and 30% of participants demonstrated hypogeusia. Self-reported neurologic dysfunction did not correlate with dysfunction on quantitative neurologic testing. Additionally, self-reported symptoms and comorbidities were associated with depression and anxiety. The study cohort performed worse on cognitive measures compared to demographically matched controls, and African American patients scored lower compared to non-Hispanic White patients on all quantitative cognitive testing. Conclusion Our results support the growing evidence that there are chronic neuropsychiatric symptoms following COVID-19 infection. Our results suggest that self-reported neurologic symptoms do not appear to correlate with associated quantitative dysfunction, emphasizing the importance of quantitative measurements in the complete assessment of deficits. Self-reported symptoms are associated with depression and anxiety. COVID-19 infection appears to be associated with worse performance on cognitive measures, though the disparity in score between African American patients and non-Hispanic White patients is likely largely due to psychosocial, physical health, and socioeconomic factors. Neuropsychiatric symptoms are often reported following COVID-19 infection. Self-reported symptoms may not be associated with objective dysfunction. Self-reported symptoms may be associated with depression and anxiety. Cognitive testing may overestimate clinical impairment in disadvantaged populations.
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86
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The Impact of Mild COVID-19 on Executive Functioning and Mental Health Outcomes in Young Adults. Healthcare (Basel) 2022; 10:healthcare10101891. [PMID: 36292338 PMCID: PMC9601355 DOI: 10.3390/healthcare10101891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 is associated with a range of long-lasting symptoms related to cognitive and psycho-emotional spheres. Even mild cases of the disease can lead to persistent cognitive deficits and deterioration of the psycho-emotional state. The purpose of our study was to examine the presence and frequency of psycho-emotional disorders and cognitive deficits in students who recovered from mild form of COVID-19. A total of 40 COVID-19 survivors and 25 healthy controls participated in our study. We assessed three core cognitive functions (inhibition, working memory, task-switching), reaction time and motor speed. We also assessed depression, anxiety and fatigue with self-report questionnaires. The COVID-19 group manifested increased depression and decreased inhibition in comparison with the controls. Our results show that even in young adults who have recovered from mild COVID-19, there are persisting cognitive and psycho-emotional deficits.
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87
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Yang J, Song H, Hao X. Whole-transcriptome sequencing data reveals a disparate cognitive and immune signature in COVID-19 patients with and without dementia. J Med Virol 2022; 95:e28177. [PMID: 36168207 PMCID: PMC9538945 DOI: 10.1002/jmv.28177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/24/2022] [Accepted: 09/24/2022] [Indexed: 01/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 6.3 million deaths worldwide. Recent evidence has indicated that elderly people with dementia are particularly vulnerable to COVID-19 and severe disease outcomes. However, its molecular mechanism remains largely unknown. Here, we retrieved frontal cortex samples of COVID-19 patients from the Gene Expression Omnibus database and performed a systematic transcriptomic analysis to compare COVID-19 patients and controls with or without dementia. In nondemented patients, SARS-CoV-2 infection obviously activated T helper type 2 (Th2) cell-mediated humoral immunity and reduced the pathogenesis of dementia-related Alzheimer's disease and Parkinson's disease. In demented patients, conversely, SARS-CoV-2 infection significantly increased T helper type 1 (Th1) cell-mediated cellular immunity and exacerbated the progression of dementia-related diseases. We further analyzed the molecular characteristics of COVID-19 patients with and without dementia. Compared with nondemented COVID-19 patients, demented COVID-19 patients showed decreased enrichment scores of Calcium signaling pathway, Neuroactive ligand-receptor interaction, ABC transporters, and Peroxisome, and increased enrichment scores of Olfactory transduction and Regulation of autophagy. The ratio of Th1/Th2 cells was significantly increased from 1.17 in nondemented COVID-19 patients to 33.32 in demented COVID-19 patients. Taken together, our findings provide transcriptomic evidence that COVID-19 has distinct influences on cognitive function and immune response in patients with and without dementia.
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Affiliation(s)
- Jue Yang
- The State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang & State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of SciencesShanghaiChina,The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
| | - Hui Song
- The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
| | - Xiaojiang Hao
- The State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang & State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of SciencesShanghaiChina,The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
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de Erausquin GA, Snyder H, Brugha TS, Seshadri S, Carrillo M, Sagar R, Huang Y, Newton C, Tartaglia C, Teunissen C, Håkanson K, Akinyemi R, Prasad K, D'Avossa G, Gonzalez‐Aleman G, Hosseini A, Vavougios GD, Sachdev P, Bankart J, Mors NPO, Lipton R, Katz M, Fox PT, Katshu MZ, Iyengar MS, Weinstein G, Sohrabi HR, Jenkins R, Stein DJ, Hugon J, Mavreas V, Blangero J, Cruchaga C, Krishna M, Wadoo O, Becerra R, Zwir I, Longstreth WT, Kroenenberg G, Edison P, Mukaetova‐Ladinska E, Staufenberg E, Figueredo‐Aguiar M, Yécora A, Vaca F, Zamponi HP, Re VL, Majid A, Sundarakumar J, Gonzalez HM, Geerlings MI, Skoog I, Salmoiraghi A, Boneschi FM, Patel VN, Santos JM, Arroyo GR, Moreno AC, Felix P, Gallo C, Arai H, Yamada M, Iwatsubo T, Sharma M, Chakraborty N, Ferreccio C, Akena D, Brayne C, Maestre G, Blangero SW, Brusco LI, Siddarth P, Hughes TM, Zuñiga AR, Kambeitz J, Laza AR, Allen N, Panos S, Merrill D, Ibáñez A, Tsuang D, Valishvili N, Shrestha S, Wang S, Padma V, Anstey KJ, Ravindrdanath V, Blennow K, Mullins P, Łojek E, Pria A, Mosley TH, Gowland P, Girard TD, Bowtell R, Vahidy FS. Chronic neuropsychiatric sequelae of SARS-CoV-2: Protocol and methods from the Alzheimer's Association Global Consortium. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12348. [PMID: 36185993 PMCID: PMC9494609 DOI: 10.1002/trc2.12348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 12/27/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions. Results Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe. Discussion The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection. Key Points The following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.
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89
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Orfei MD, Porcari DE, D’Arcangelo S, Maggi F, Russignaga D, Ricciardi E. A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome. J Clin Med 2022; 11:jcm11195529. [PMID: 36233392 PMCID: PMC9573330 DOI: 10.3390/jcm11195529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Epidemiological data and etiopathogenesis of brain fog are very heterogeneous in the literature, preventing adequate diagnosis and treatment. Our study aimed to explore the relationship between brain fog, neuropsychiatric and cognitive symptoms in the general population. A sample of 441 subjects underwent a web-based survey, including the PANAS, the DASS-21, the IES-R, the Beck Cognitive Insight Scale, and a questionnaire investigating demographic information, brain fog, subjective cognitive impairments (Scc) and sleep disorders. ANOVA, ANCOVA, correlation and multiple stepwise regression analyses were performed. In our sample, 33% of participants were defined as Healthy Subjects (HS; no brain fog, no Scc), 27% as Probable Brain Fog (PBF; brain fog or Scc), and 40% as Functional Brain Fog (FBF; brain fog plus Scc). PBF and FBF showed higher levels of neuropsychiatric symptoms than HS, and FBF showed the worst psychological outcome. Moreover, worse cognitive symptoms were related to the female gender, greater neuropsychiatric symptoms, sleep disorders, and rumination/indecision. Being a woman and more severe neuropsychiatric symptoms were predictors of FBF severity. Our data pointed out a high prevalence and various levels of severity and impairments of brain fog, suggesting a classificatory proposal and a multifaceted etiopathogenic model, thus facilitating adequate diagnostic and therapeutic approaches.
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Affiliation(s)
- Maria Donata Orfei
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
- Correspondence:
| | - Desirée Estela Porcari
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Sonia D’Arcangelo
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Francesca Maggi
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Dario Russignaga
- Intesa Sanpaolo S.p.A., HSE Office, Via Lorenteggio 266, 20152 Milan, Italy
| | - Emiliano Ricciardi
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
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Picone P, Sanfilippo T, Guggino R, Scalisi L, Monastero R, Baschi R, Mandalà V, San Biagio L, Rizzo M, Giacomazza D, Dispenza C, Nuzzo D. Neurological Consequences, Mental Health, Physical Care, and Appropriate Nutrition in Long-COVID-19. Cell Mol Neurobiol 2022:10.1007/s10571-022-01281-w. [PMID: 36103031 PMCID: PMC9472192 DOI: 10.1007/s10571-022-01281-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
SARS-CoV-2 pandemic has caused a collapse of the world health systems. Now, vaccines and more effective therapies have reversed this crisis but the scenario is further aggravated by the appearance of a new pathology, occurring as SARS-CoV-2 infection consequence: the long-COVID-19. This term is commonly used to describe signs and symptoms that continue or develop after acute infection of COVID-19 up to several months. In this review, the consequences of the disease on mental health and the neurological implications due to the long-COVID are described. Furthermore, the appropriate nutritional approach and some recommendations to relieve the symptoms of the pathology are presented. Data collected indicated that in the next future the disease will affect an increasing number of individuals and that interdisciplinary action is needed to counteract it.
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91
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Priftis K, Velardo V, Vascello MGF, Villella S, Galeri S, Spada MS, Algeri L. Limited evidence for neuropsychological dysfunction in patients initially affected by severe COVID-19. Neurol Sci 2022; 43:6661-6663. [PMID: 36050424 PMCID: PMC9436465 DOI: 10.1007/s10072-022-06373-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Konstantinos Priftis
- Department of General Psychology, University of Padua, Via Venezia 8, Padua, Italy.
- Human Inspired Technology Center, University of Padua, Padua, Italy.
| | - Valeria Velardo
- Rehabilitation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Stella Villella
- Rehabilitation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Silvia Galeri
- Rehabilitation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Lorella Algeri
- Rehabilitation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
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92
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Cognitive function in non-hospitalized patients 8–13 months after acute COVID-19 infection: A cohort study in Norway. PLoS One 2022; 17:e0273352. [PMID: 35994448 PMCID: PMC9394790 DOI: 10.1371/journal.pone.0273352] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score <-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8–13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4–14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6–9 symptoms vs. 0–5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome.
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93
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Voruz P, Jacot de Alcântara I, Nuber-Champier A, Cionca A, Allali G, Benzakour L, Lalive PH, Lövblad KO, Braillard O, Nehme M, Coen M, Serratrice J, Reny JL, Pugin J, Guessous I, Ptak R, Landis BN, Assal F, Péron JA. Frequency of Abnormally Low Neuropsychological Scores in Post-COVID-19 Syndrome: the Geneva COVID-COG Cohort. Arch Clin Neuropsychol 2022; 38:1-11. [PMID: 35942646 PMCID: PMC9384624 DOI: 10.1093/arclin/acac068] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Several studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods. METHOD Validated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data. RESULTS The cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits. CONCLUSIONS Moderate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection.
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Affiliation(s)
- P Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland,Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - I Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland,Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - A Nuber-Champier
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - A Cionca
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - G Allali
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland,Faculty of Medicine, University of Geneva, Geneva, Switzerland,Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - L Benzakour
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Psychiatry Department, Geneva University Hospitals, Geneva, Switzerland
| | - P H Lalive
- Department of Clinical Neurosciences, Neurology Department, Geneva University Hospitals, Geneva, Switzerland,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - K-O Lövblad
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Diagnostic and Interventional Neuroradiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - O Braillard
- Division and Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - M Nehme
- Division and Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - M Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - J Serratrice
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - J-L Reny
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - J Pugin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - I Guessous
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Division and Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - R Ptak
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Neurorehabilitation Department, Geneva University Hospitals, Geneva, Switzerland
| | - B N Landis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Rhinology-Olfactology Unit, Otorhinolaryngology Department, Geneva University Hospitals, Geneva Switzerland
| | | | - J A Péron
- Corresponding author at: Faculté de Psychologie et des Sciences de l'Education, 40 bd du Pont d’Arve, 1205 Geneva, Switzerland. Tel.: +41-22-379-94-55; Fax: 0041 22 379 93 59.E-mail address: (J.A. Péron)
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94
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Smith CJ, Renshaw P, Yurgelun-Todd D, Sheth C. Acute and chronic neuropsychiatric symptoms in novel coronavirus disease 2019 (COVID-19) patients: A qualitative review. Front Public Health 2022; 10:772335. [PMID: 36033820 PMCID: PMC9404694 DOI: 10.3389/fpubh.2022.772335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/11/2022] [Indexed: 01/21/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a global pandemic by the World Health Organization (WHO) on March 11th, 2020. It has had unprecedented adverse effects on healthcare systems, economies, and societies globally. SARS-CoV-2 is not only a threat to physical health but has also been shown to have a severe impact on neuropsychiatric health. Many studies and case reports across countries have demonstrated insomnia, depressed mood, anxiety, post-traumatic stress disorder (PTSD), and cognitive change in COVID-19 patients during the acute phase of the infection, as well as in apparently recovered COVID-19 patients. The goal of this narrative review is to synthesize and summarize the emerging literature detailing the neuropsychiatric manifestations of COVID-19 with special emphasis on the long-term implications of COVID-19.
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Affiliation(s)
- Calen J. Smith
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, United States
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, United States
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States
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García-Molina A, García-Carmona S, Espiña-Bou M, Rodríguez-Rajo P, Sánchez-Carrión R, Enseñat-Cantallops A. [Neuropsychological rehabilitation for post-COVID-19 syndrome: Results of a clinical program and six-month follow up.]. Neurologia 2022:S0213-4853(22)00087-1. [PMID: 35936979 PMCID: PMC9345851 DOI: 10.1016/j.nrl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Patients with post-COVID-19 syndrome may present cognitive and emotional symptomatology. This study aims to analyse the results of an outpatient neuropsychological intervention program for post-COVID-19 syndrome. METHOD In June 2020 Institut Guttmann started an outpatient post-COVID-19 neurorehabilitation program, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation. Before and after the program, the cognitive-emotional state of all participants is assessed. Six months after treatment, a follow-up assessment is administered (which includes a collection of information on various aspects of daily life). RESULTS The sample analysed consisted of 123 patients (mean age: 51 years, SD: 12.41). Seventy-four per cent (n=91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n=32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living. CONCLUSIONS Neuropsychological rehabilitation is an effective tool to treat the cognitive-emotional deficits present in post-COVID-19 syndrome. However, months after the end of treatment, not all patients recover their pre-COVID-19 functional level.
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Affiliation(s)
- Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio García-Carmona
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miguel Espiña-Bou
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pablo Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rocío Sánchez-Carrión
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Antonia Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
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96
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Cognitive phenotyping of post-infectious SARS-CoV-2 patients. Neurol Sci 2022; 43:4599-4604. [PMID: 35604618 PMCID: PMC9125346 DOI: 10.1007/s10072-022-06130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Background SARS-CoV-2 infection entails neuroinvasive, neuroinflammatory, and treatment-related features accounting for cognitive deficits in COVID-19-recovered patients. Although screening for such dysfunctions in this population is considered clinically relevant, contributions to cognitive phenotyping including premorbid and disease-related confounders are scarcely represented. This study thus aimed at describing the cognitive outcome at the function-/domain-level of post-infectious SARS-CoV-2 patients being already at risk (RCD +) or not (RCD −) for cognitive decline. Methods Fifty-four COVID-19-recovered individuals were classified as either RCD + or RCD − according to medical records. The Mini-Mental State Examination (MMSE), Addebrooke Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery (FAB), and Attentive Matrices (AM) were administered (N = 54, 34, 28, and 28 patients, respectively). Results Prevalence of defective (cutoff = 24.89) MMSE scores was 24.3% in RCD + patients and 5.9% in the RCD − group. ACE-R-total below cutoff scores were less frequent (RCD + : 5.4%; RCD − : 5.9%). Abnormal performances at the FAB an AM were respectively detected in 18.9% and 8.1% of RCD + patients and 0% and 11.8% of the RCD − group. Within the ACE-R subtests, those assessing orientation, attention, and fluency were the most frequently impaired in both groups. Disease-related variables were mostly unassociated with cognitive measures. Discussion Both RCD + and RCD − COVID-19-recovered individuals might show cognitive deficits within the dysexecutive-inattentive and amnesic spectrum. Non-instrumental, executive/attentive dysfunctions are predominant in this population and can be detected by both screening and domain-specific psychometric tests—although the latter might be more sensitive in RCD − patients.
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97
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Neurocognitive screening in patients following SARS-CoV-2 infection: tools for triage. BMC Neurol 2022; 22:285. [PMID: 35907815 PMCID: PMC9338515 DOI: 10.1186/s12883-022-02817-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/23/2022] [Indexed: 02/05/2023] Open
Abstract
Background Cognitive complaints are common in patients recovering from Coronavirus Disease 2019 (COVID-19), yet their etiology is often unclear. We assess factors that contribute to cognitive impairment in ambulatory versus hospitalized patients during the sub-acute stage of recovery. Methods In this cross-sectional study, participants were prospectively recruited from a hospital-wide registry. All patients tested positive for SARS-CoV-2 infection using a real-time reverse transcriptase polymerase-chain-reaction assay. Patients ≤ 18 years-of-age and those with a pre-existing major neurocognitive disorder were excluded. Participants completed an extensive neuropsychological questionnaire and a computerized cognitive screen via remote telemedicine platform. Rates of subjective and objective neuropsychological impairment were compared between the ambulatory and hospitalized groups. Factors associated with impairment were explored separately within each group. Results A total of 102 patients (76 ambulatory, 26 hospitalized) completed the symptom inventory and neurocognitive tests 24 ± 22 days following laboratory confirmation of SARS-CoV-2 infection. Hospitalized and ambulatory patients self-reported high rates of cognitive impairment (27–40%), without differences between the groups. However, hospitalized patients showed higher rates of objective impairment in visual memory (30% vs. 4%; p = 0.001) and psychomotor speed (41% vs. 15%; p = 0.008). Objective cognitive test performance was associated with anxiety, depression, fatigue, and pain in the ambulatory but not the hospitalized group. Conclusions Focal cognitive deficits are more common in hospitalized than ambulatory patients. Cognitive performance is associated with neuropsychiatric symptoms in ambulatory but not hospitalized patients. Objective neurocognitive measures can provide essential information to inform neurologic triage and should be included as endpoints in clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02817-9.
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98
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Tarantino S, Graziano S, Carducci C, Giampaolo R, Grimaldi Capitello T. Cognitive Difficulties, Psychological Symptoms, and Long Lasting Somatic Complaints in Adolescents with Previous SARS-CoV-2 Infection: A Telehealth Cross-Sectional Pilot Study. Brain Sci 2022; 12:brainsci12080969. [PMID: 35892410 PMCID: PMC9332506 DOI: 10.3390/brainsci12080969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
Background. Few studies have evaluated cognitive functioning and mental health in children and adolescents who contracted the SARS-CoV-2 infection. We investigated the prevalence and association of neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints in a sample of adolescents. Methods. Thirty-one adolescents infected by COVID-19 within 3–6 months prior to the assessment were included. Neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints were evaluated using a checklist and a battery of multiple standardized measures, using a telehealth procedure. Symptoms during the infection were also detected. Results. We included 31 adolescents (23 girls, 8 boys; mean age 14.1, SD = 2). We found borderline scores in 32.3% and 45.2% of our sample for phonemic and category fluency, respectively. A high percentage of participants showed symptoms of depression (80.6%) and anxiety (61.3%). Fifty-eight percent reported at least one long-COVID symptom. The most common symptoms were headache and attention problems (58%). Subjects presenting numbness/weakness, fatigue, brain fog, or attention problems had higher scores in depression, anxiety, and post-traumatic stress symptoms (p ≤ 0.05). Conclusion. This is a pilot study limited by the lack of control group. However, we found that cognitive, psychological, and physical symptoms were very common among adolescents recovered from COVID-19.
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Affiliation(s)
- Samuela Tarantino
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
- Correspondence: ; Tel.: +39-0668592228
| | - Sonia Graziano
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
| | - Chiara Carducci
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
| | - Rosaria Giampaolo
- Department of Paediatric Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Teresa Grimaldi Capitello
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
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99
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Nanjo Y, Okuma T, Kuroda Y, Hayakawa E, Shibayama K, Akimoto T, Murashima R, Kanamori K, Tsutsumi T, Suzuki Y, Namba Y, Makino F, Nagashima O, Sasaki S, Takahashi K. Multiple Types of Taste Disorders among Patients with COVID-19. Intern Med 2022; 61:2127-2134. [PMID: 35527025 PMCID: PMC9381347 DOI: 10.2169/internalmedicine.9065-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Based on the increasing incidence of smell and taste dysfunction among coronavirus disease 2019 (COVID-19) patients, such issues have been considered an early symptom of infection. However, few studies have investigated the type of taste components that are most frequently affected in COVID-19 patients. This study investigated the difference in frequencies of the types of taste component disorders among hospitalized COVID-19 patients. Methods In this retrospective, single-center, observational study, patients' background characteristics, clinical course, laboratory and radiological findings, and details on taste and/or smell disorders were collected and analyzed from medical records. Patients A total of 227 COVID-19 patients were enrolled, among whom 92 (40.5%) complained of taste disorders. Results Multiple types of taste disorders (hypogeusia/ageusia and hypersensitivity, or hypersensitivity and changing tastes) were reported in 10 patients. In particular, 23 patients reported hypersensitivity to at least 1 type of taste, and 2 patients complained of a bitter taste on consuming sweet foods. Impairment of all taste components was found in 48 patients (52.2%). The most frequent taste disorder was salty taste disorder (81 patients, 89.0%). Hypersensitivity to salty taste was most frequently observed (19 patients, 20.9%). Conclusion Patients with COVID-19 develop multiple types of taste disorders, among which salty taste disorder was the most frequent, with many patients developing hypersensitivity to salty taste. As smell and taste are subjective senses, further studies with the combined use of objective examinations will be required to confirm the findings.
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Affiliation(s)
- Yuta Nanjo
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Tomoko Okuma
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yumi Kuroda
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Eri Hayakawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kohei Shibayama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takashi Akimoto
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Ryoko Murashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yohei Suzuki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Fumihiko Makino
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Osamu Nagashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Shinichi Sasaki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
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100
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Valdes E, Fuchs B, Morrison C, Charvet L, Lewis A, Thawani S, Balcer L, Galetta SL, Wisniewski T, Frontera JA. Demographic and social determinants of cognitive dysfunction following hospitalization for COVID-19. J Neurol Sci 2022; 438:120146. [PMID: 35031121 PMCID: PMC8739793 DOI: 10.1016/j.jns.2022.120146] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/28/2021] [Accepted: 01/04/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Persistent cognitive symptoms have been reported following COVID-19 hospitalization. We investigated the relationship between demographics, social determinants of health (SDOH) and cognitive outcomes 6-months after hospitalization for COVID-19. METHODS We analyzed 6-month follow-up data collected from a multi-center, prospective study of hospitalized COVID-19 patients. Demographic and SDOH variables (age, race/ethnicity, education, employment, health insurance status, median income, primary language, living arrangements, and pre-COVID disability) were compared between patients with normal versus abnormal telephone Montreal Cognitive Assessments (t-MOCA; scores<18/22). Multivariable logistic regression models were constructed to evaluate predictors of t-MoCA. RESULTS Of 382 patients available for 6-month follow-up, 215 (56%) completed the t-MoCA (n = 109/215 [51%] had normal and n = 106/215 [49%] abnormal results). 14/215 (7%) patients had a prior history of dementia/cognitive impairment. Significant univariate predictors of abnormal t-MoCA included older age, ≤12 years of education, unemployment pre-COVID, Black race, and a pre-COVID history of cognitive impairment (all p < 0.05). In multivariable analyses, education ≤12 years (adjusted OR 5.21, 95%CI 2.25-12.09), Black race (aOR 5.54, 95%CI 2.25-13.66), and the interaction of baseline functional status and unemployment prior to hospitalization (aOR 3.98, 95%CI 1.23-12.92) were significantly associated with abnormal t-MoCA scores after adjusting for age, history of dementia, language, neurological complications, income and discharge disposition. CONCLUSIONS Fewer years of education, Black race and unemployment with baseline disability were associated with abnormal t-MoCA scores 6-months post-hospitalization for COVID-19. These associations may be due to undiagnosed baseline cognitive dysfunction, implicit biases of the t-MoCA, other unmeasured SDOH or biological effects of SARS-CoV-2.
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Affiliation(s)
- Eduard Valdes
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Benjamin Fuchs
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Chris Morrison
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sujata Thawani
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
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