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Ferrucci R, Dini M, Rosci C, Capozza A, Groppo E, Reitano MR, Allocco E, Poletti B, Brugnera A, Bai F, Monti A, Ticozzi N, Silani V, Centanni S, D’Arminio Monforte A, Tagliabue L, Priori A. One‐Year Cognitive Follow‐Up of COVID‐19 Hospitalized Patients. Eur J Neurol 2022; 29:2006-2014. [PMID: 35285122 PMCID: PMC9111730 DOI: 10.1111/ene.15324] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/12/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Methods Results Conclusion
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Affiliation(s)
- Roberta Ferrucci
- Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain therapeutics Department of Health Sciences University of Milan 20142 Milan Italy
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Michelangelo Dini
- Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain therapeutics Department of Health Sciences University of Milan 20142 Milan Italy
| | - Chiara Rosci
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Antonella Capozza
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Elisabetta Groppo
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Maria R. Reitano
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Elisa Allocco
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience IRCCS Istituto Auxologico Italiano 20149 Milan Italy
| | - Agostino Brugnera
- Department of Human and Social sciences University of Bergamo 24129 Bergamo Italy
| | - Francesca Bai
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences Casa di Cura Policlinico 20144 Milan Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience IRCCS Istituto Auxologico Italiano 20149 Milan Italy
- Department of Pathophysiology and Transplantation Dino Ferrari” Center University of Milano 20122 Milan Italy
| | - Vincenzo Silani
- Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain therapeutics Department of Health Sciences University of Milan 20142 Milan Italy
- Department of Neurology and Laboratory of Neuroscience IRCCS Istituto Auxologico Italiano 20149 Milan Italy
- Department of Pathophysiology and Transplantation Dino Ferrari” Center University of Milano 20122 Milan Italy
| | - Stefano Centanni
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
- Department of Health Sciences (DISS) University of Milan 20142 Milan Italy
| | - Antonella D’Arminio Monforte
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
- Department of Health Sciences (DISS) University of Milan 20142 Milan Italy
| | - Luca Tagliabue
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
| | - Alberto Priori
- Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain therapeutics Department of Health Sciences University of Milan 20142 Milan Italy
- ASST Santi Paolo e Carlo San Paolo University Hospital 20142 Milan Italy
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Sahoo S, Suman A, Mehra A, Nehra R, Bhalla A, Puri GD, Grover S. Cognitive Deficits in Patients with COVID-19 Infection during Their Hospital Stay: An Exploratory Study. J Neurosci Rural Pract 2022; 13:236-245. [PMID: 35694064 PMCID: PMC9187408 DOI: 10.1055/s-0042-1743445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98; median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%; n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26; 39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence Swapnajeet Sahoo, MD Department of Psychiatry, Post Graduate Institute of Medical Education and ResearchChandigarh 160012India
| | - Arzoo Suman
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cognitive, EEG, and MRI features of COVID-19 survivors: a 10-month study. J Neurol 2022; 269:3400-3412. [PMID: 35249144 PMCID: PMC8898558 DOI: 10.1007/s00415-022-11047-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/21/2023]
Abstract
Background and objectives To explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge. Methods Adult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed. Results At baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up. Discussion COVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11047-5.
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Okolichany R, Padala P, Mooney S. Cognitive and Functional Abilities in an Older Adult Veteran Before and After Contracting COVID-19. J Alzheimers Dis Rep 2022; 6:115-120. [PMID: 35530116 PMCID: PMC9028709 DOI: 10.3233/adr-210055] [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: 10/26/2021] [Accepted: 02/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background: A 76-year-old male Veteran with a historical diagnosis of mild cognitive impairment was assessed at baseline and follow-up as part of two separate, ongoing studies. He was diagnosed with COVID-19 during the interim. Objective: To report potential effects on cognitive and functional abilities measured before and after contracting COVID-19. Methods: The patient was administered a series of cognitive tests and self-report procedures assessing cognitive, functional, and neuropsychiatric status. Results: Overall, no discernable pattern of cognitive changes between pre-COVID and post-COVID assessments were noted. Only mild increases in agitation, depression, and irritability were noted on a self-report measure. However, this particular subject has relatively ideal psychosocial circumstances in comparison to the typical older adult Veteran male. It is hypothesized that improved psychosocial conditions will result in less negative cognitive and functional outcomes for older adults diagnosed with COVID-19. Conclusion: High levels of resilience, social support, and exercise, coupled with lower levels of perceived stress and loneliness may serve as protective factors against cognitive and functional decline in older adults who contract COVID-19.
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Affiliation(s)
- Ronald Okolichany
- Geriatric Research Education and Clinical Center(GRECC), Central Arkansas Veterans Healthcare System, North LittleRock, AR, USA
| | - Prasad Padala
- Geriatric Research Education and Clinical Center(GRECC), Central Arkansas Veterans Healthcare System, North LittleRock, AR, USA
| | - Scott Mooney
- Neuropsychology Service, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
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155
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The cognitive and psychiatric subacute impairment in severe Covid-19. Sci Rep 2022; 12:3563. [PMID: 35241761 PMCID: PMC8894467 DOI: 10.1038/s41598-022-07559-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains and the existence of related biomarkers. Cross-sectional multicentric study of patients who survived severe infection with SARS-CoV-2 consecutively recruited between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory, neurotrophic factors and light-chain neurofilaments. A principal component analysis extracted the main independent characteristics of the syndrome. 152 patients were recruited. The results of our study preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of other cortical functions. In addition, anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population. Severe Covid-19 patients can develop an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and if this can trigger or accelerate the onset of neurodegenerative diseases.
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Henneghan A, Lewis KA, Gill E, Franco-Rocha OY, Vela RD, Medick S, Kesler S. Describing cognitive function and psychosocial outcomes of COVID-19 survivors: A cross-sectional analysis. J Am Assoc Nurse Pract 2022; 34:499-508. [PMID: 34469360 PMCID: PMC8882196 DOI: 10.1097/jxx.0000000000000647] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurological and psychological symptoms are increasingly realized in the post-acute phase of COVID-19. PURPOSE To examine and characterize cognitive and related psychosocial symptoms in adults (21-75 years) who tested positive for or were treated as positive for COVID-19. METHODS In this cross-sectional study, data collection included a cognitive testing battery (Trails B; Digit Symbol; Stroop; Immediate and Delayed Verbal Learning) and surveys (demographic/clinical history; self-reported cognitive functioning depressive symptoms, fatigue, anxiety, sleep disturbance, social role performance, and stress). Results were compared with published norms, rates of deficits (more than 1 standard deviation (SD) from the norm) were described, and correlations were explored. RESULTS We enrolled 52 participants (mean age 37.33 years; 78.85% female) who were, on average, 4 months post illness. The majority had a history of mild or moderate COVID-19 severity. Forty percent of participants demonstrated scores that were 1 SD or more below the population norm on one or more of the cognitive tests. A subset had greater anxiety (21.15%), depressive symptoms (23.07%), and sleep disturbance (19.23%) than population norms. Age differences were identified in Stroop, Digit Symbol, and Trails B scores by quartile ( p < .01), with worse performance in those 28-33 years old. CONCLUSIONS Cognitive dysfunction and psychological symptoms may be present in the weeks or months after COVID-19 diagnosis, even in those with mild to moderate illness severity. IMPLICATIONS FOR PRACTICE Clinicians need to be aware and educate patients about the potential late/long-term cognitive and psychological effects of COVID-19, even in mild to moderate disease.
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Affiliation(s)
- Ashley Henneghan
- Assistant Professor, School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St. Austin, TX, U.S., 78712
| | - Kimberly A. Lewis
- Nurse Scientist, Department of Nursing Research, Ascension Texas, Austin, TX
- Postdoctoral Scholar, Department of Physiological Nursing, University of California at San Francisco, CA 94143
| | - Eliana Gill
- Predoctoral Student, School of Nursing, The University of Texas at Austin, 1710 Red River St. Austin, TX, U.S., 78712
- Registered Nurse, Ascension Seton Medical Center Austin, 1201 W. 38 St. Austin, TX 78705
| | - Oscar Y. Franco-Rocha
- School of Nursing, The University of Texas at Austin. 1710 Red River St. Austin, TX, 78712
| | - Ruben D. Vela
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sarah Medick
- School of Nursing, The University of Texas at Austin. 1710 Red River St. Austin, TX, 78712
| | - Shelli Kesler
- Associate Professor, School of Nursing, Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX
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Abstract
OBJECTIVES Mental fatigue, 'brain fog', and difficulties maintaining engagement are commonly reported issues in a range of neurological and psychiatric conditions. Traditional sustained attention tasks commonly measure this capacity as the ability to detect target stimuli based on sensory features in the auditory or visual domains. However, with this approach, discrete target stimuli may exogenously capture attention to aid detection, thereby masking deficits in the ability to endogenously sustain attention over time. METHODS To address this, we developed the Continuous Temporal Expectancy Task (CTET) where individuals continuously monitor a stream of patterned stimuli alternating at a fixed temporal interval (690 ms) and detect an infrequently occurring target stimulus defined by a prolonged temporal duration (1020 ms or longer). As such, sensory properties of target and non-target stimuli are perceptually identical and differ only in temporal duration. Using the CTET, we assessed stroke survivors with unilateral right hemisphere damage (N = 14), a cohort in which sustained attention deficits have been extensively reported. RESULTS Stroke survivors had overall lower target detection accuracy compared with neurologically healthy age-matched older controls (N = 18). Critically, stroke survivors performance was characterised by significantly steeper within-block performance decrements, which occurred within short temporal windows (˜3 ½ min), and were restored by the break periods between blocks. CONCLUSIONS These findings suggest that continuous temporal monitoring taxes sustained attention processes to capture clinical deficits in this capacity over time, and outline a precise measure of the endogenous processes hypothesised to underpin sustained attention deficits following right hemisphere stroke.
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García-Sánchez C, Calabria M, Grunden N, Pons C, Arroyo JA, Gómez-Anson B, Lleó A, Alcolea D, Belvís R, Morollón N, Mur I, Pomar V, Domingo P. Neuropsychological deficits in patients with cognitive complaints after COVID-19. Brain Behav 2022; 12:e2508. [PMID: 35137561 PMCID: PMC8933779 DOI: 10.1002/brb3.2508] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND While much of the scientific focus thus far has been on cognitive sequelae in patients with severe COVID-19, subjective cognitive complaints are being reported across the spectrum of disease severity, with recent studies beginning to corroborate patients' perceived deficits. In response to this, the aims of this study were to (1) explore the frequency of impaired performance across cognitive domains in post-COVID patients with subjective complaints and (2) uncover whether impairment existed within a single domain or across multiple. METHODS Sixty-three patients with subjective cognitive complaints post-COVID were assessed with a comprehensive protocol consisting of various neuropsychological tests and mood measures. Cognitive test performance was transformed into T scores and classified based on recommended guidelines. After performing a principal component analysis to define cognitive domain factors, distributions of test scores within and across domains were analyzed. RESULTS Results revealed pervasive impact on attention abilities, both as the singularly affected domain (19% of single-domain impairment) as well as coupled with decreased performance in executive functions, learning, and long-term memory. These salient attentional and associated executive deficits were largely unrelated to clinical factors such as hospitalization, disease duration, biomarkers, or affective measures. DISCUSSION These findings stress the importance of comprehensive evaluation and intervention to address cognitive sequelae in post-COVID patients of varying disease courses, not just those who were hospitalized or experienced severe symptoms. Future studies should investigate to what extent these cognitive abilities are recuperated over time as well as employ neuroimaging techniques to uncover underlying mechanisms of neural damage.
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Affiliation(s)
- Carmen García-Sánchez
- Neuropsychology Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marco Calabria
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Nicholas Grunden
- Department of Psychology, Concordia University, Montreal, Canada
| | - Catalina Pons
- Facultat de Psicologia, Ciències de l'Educació i l'Esport, Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Juan Antonio Arroyo
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Beatriz Gómez-Anson
- Neurodiagnostic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alberto Lleó
- Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roberto Belvís
- Headache Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Noemí Morollón
- Headache Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Mur
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Domingo
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Vannorsdall TD, Brigham E, Fawzy A, Raju S, Gorgone A, Pletnikova A, Lyketsos CG, Parker AM, Oh ES. Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19. J Acad Consult Liaison Psychiatry 2022; 63:133-143. [PMID: 34793996 PMCID: PMC8591857 DOI: 10.1016/j.jaclp.2021.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. OBJECTIVE We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients. METHODS Approximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function. RESULTS Most Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%-32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores. CONCLUSIONS At approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.
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Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Emily Brigham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarath Raju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alesandra Gorgone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra Pletnikova
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann M Parker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing, Baltimore, MD
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Babnik K, Staresinic C, Lep Ž. Some of the workforce face post COVID after the acute phase of the illness: The employer’s supportive role. HUMAN SYSTEMS MANAGEMENT 2022. [DOI: 10.3233/hsm-220003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: A considerable proportion of workers that recover from an acute phase of COVID-19 are confronted with post COVID-19 symptoms of varying severity and duration. Employers have an important role in addressing this new condition. OBJECTIVE: The aim of this study was to review organisational practises that could help employees suffering from long COVID-19 return to work and to link these suggestions to theoretical frameworks from the field of work and organisational psychology. METHODS: Since scientific publications on post COVID-19 are published daily, but sound empirical studies are still scarce, the synthesis of the scientific and professional literature was performed in the form of a narrative review. RESULTS: The results were organised according to the healthy workplace model and explained through the lens of the job demands-resources theory. The role of the employer has three aspects: collaboration, instructional pillars, and key actors. The main guidelines for implementation of the policies are an individualised approach, flexibility, and support. Supportive policies, practises, and relationships might have a direct impact on workers’ psychological resources. CONCLUSIONS: The model could help employers understand the conditions and necessary adaptations for workers with post COVID-19, as well as advance research in work and organisational psychology.
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Affiliation(s)
- Katarina Babnik
- Department of Psychology, University of Ljubljana, Faculty of Arts, Ljubljana, Slovenia
| | - Claire Staresinic
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Žan Lep
- Department of Psychology, University of Ljubljana, Faculty of Arts, Ljubljana, Slovenia
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Henneghan AM, Lewis KA, Gill E, Kesler SR. Cognitive Impairment in Non-critical, Mild-to-Moderate COVID-19 Survivors. Front Psychol 2022; 13:770459. [PMID: 35250714 PMCID: PMC8891805 DOI: 10.3389/fpsyg.2022.770459] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/21/2022] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Previous studies of post-acute COVID-19 syndrome have focused on critical cases with severe disease. However, most cases are mild to moderate in disease severity. OBJECTIVE We aimed to examine cognitive outcomes in cases of non-critical, mild-to-moderate COVID-19. Design, Setting, and Participants: In this cross-sectional study, we enrolled 72 adults aged 22 to 65 years in Central Texas who had non-critical, mild-to-moderate COVID-19 infection between 13 January 2021 and 20 April 2021. MAIN OUTCOMES AND MEASURES We remotely administered cognitive-behavioral testing to determine the frequency of cognitive impairment and examine demographic, clinical, and psychosocial contributors to impairment. RESULTS The frequency of objective cognitive impairment was 40%. The largest number of participants (24%) showed impairment on a measure of executive functioning. Attention and processing speed was more impaired in males (OR = 1.5, 95%CI = 0.23-2.9). Males endorsed lower adherence to social distancing guidelines (U = 590, p = 0.01), which was in turn associated with cognitive impairment across participants (r = -0.30, p = 0.01). Younger age was correlated with impairment (r = -0.26, p = 0.03) but was also associated with racial/ethnic minority status (r = -0.31, p = 0.01) and increased psychological symptoms (p < 0.04). Greater number of COVID-19 symptoms was correlated with lower subjective cognitive function (r = -0.38, p = 0.001) as well as psychosocial function (r > 0.24, p < 0.05). Moderate COVID-19 severity was associated with attention/processing speed impairment (r = 0.27, p = 0.03), increased pain (r = 0.31, p = 0.01), and higher number of COVID-19 symptoms (r = 0.32, p = 0.01). CONCLUSION AND RELEVANCE Mild or moderate COVID-19 infection may be associated with cognitive impairments, especially in the domain of executive functioning. A subgroup of younger individuals may be more vulnerable to cognitive and psychosocial effects of COVID-19. HIGHLIGHTS Question: How frequent is cognitive impairment among non-critical, mild-to-moderate COVID-19 survivors? FINDINGS In this cross-sectional study of 72 adults, 40% demonstrated cognitive impairment, particularly in executive function. MEANING Neurologic sequelae, such as cognitive impairment, may be common following COVID-19 infection.
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Affiliation(s)
- Ashley M. Henneghan
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Kimberly A. Lewis
- Ascension Seton Medical Center, Austin, TX, United States
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Eliana Gill
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Ascension Seton Medical Center, Austin, TX, United States
| | - Shelli R. Kesler
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Preobrazhenskaya IS. COVID-associated cognitive impairments: A review. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.2.201512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, began in March 2020 and continues to the present. The virus most often affects the respiratory system; to date, there is evidence of possible damage to the heart, skin, kidneys, central nervous system in this disease. In this regard, it is of great interest to study the neurological features of COVID-19, in particular, the development of cognitive disorders or the increase in the severity of already existing cognitive impairments. This review provides the latest data on the relationship of COVID-19 and cognitive impairment, the proposed etiology, pathogenesis and main clinical manifestations of cognitive disorders, and also discusses possible strategies for the treatment of cognitive impairment after suffering COVID-19.
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163
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Whiteside DM, Basso MR, Naini SM, Porter J, Holker E, Waldron EJ, Melnik TE, Niskanen N, Taylor SE. Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection Part 1: Cognitive functioning. Clin Neuropsychol 2022; 36:806-828. [PMID: 35130818 DOI: 10.1080/13854046.2022.2030412] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Long-term cognitive sequelae of COVID-19 have not been extensively studied. This study provides initial results on cognitive outcomes in Post-Acute Sequelae of COVID-19 (PASC).Participants and Methods: This study examined 53 consecutive outpatients diagnosed with COVID-19. Four participants were excluded due to performance validity test failure. All participants had positive COVID-19 tests, reported cognitive concerns, and completed neuropsychological tests to assess performance validity, attention/working memory, processing speed, memory, language, visual-spatial, executive functioning, motor, and emotional functioning. The sample was mostly white (89.8%), female (83.7%), and never hospitalized (69.4%) for COVID-19. RESULTS Analyses indicated no mean scores in the Impaired range (>2 standard deviations [SD] below normative mean) on objective cognitive testing and a low base rate of Impaired test scores. Higher (>20%) base rates of Borderline performance (1-2 SDs below normative mean) were found on some measures. There was also evidence for frequently elevated mean scores on mood measures which correlated with some cognitive measures and the number of Borderline scores per participants. CONCLUSIONS The results were noteworthy for infrequent Impaired scores, and significant correlations between cognition and mood/anxiety measures, but not between cognitive performance and premorbid vascular risk factors, psychiatric diagnoses, or COVID-19 disease severity. Results suggest that psychological distress was prominent in PASC and related to objective cognitive performance, but objective cognitive performance was unrelated to cognitive complaints. Other contributing factors may include fatigue/sleep issues. Neurologically based cognitive deficits were not suggested by the results.During the COVID-19 pandemic, researchers and clinicians have gained considerable knowledge of the SARS-CoV-2 virus that causes the COVID-19 illness. Research has implicated COVID-19 in a variety of neurological and psychiatric issues (Taquet et al., 2021) including stroke, depression/anxiety, and more rarely intracranial hemorrhage and psychotic disorders. Further, various vascular risk factors such as hypertension, diabetes, hyperlipidemia, and obstructive sleep apnea (OSA) have been associated with more severe COVID-19 symptoms (Bauer et al., 2021; Luk et al., 2021; Mishra et al., 2020; Saxena et al., 2021). Additionally, while many patients recover from COVID-19 in a few weeks, a substantial number continue to experience physical (e.g., fatigue, shortness of breath, cough, palpitations) and cognitive (e.g., "brain fog", concentration and memory complaints) symptoms for a considerable period (Raveendran et al., 2021). It has also been suggested that patients themselves, via social media, contributed to reifying the phenomenon of "Long COVID-19" or post-acute sequelae of SARS-CoV-2 infection (PASC; Callard & Perego, 2021). However, very limited research exists that directly investigates the cognitive sequelae of COVID-19 infection, particularly in the long term. The current study aims to address this limitation in the literature.
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Affiliation(s)
- Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, NY, USA
| | - Savana M Naini
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA.,Department of Psychology, University of St. Thomas, Saint Paul, MN, USA
| | - James Porter
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erin Holker
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Eric J Waldron
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tanya E Melnik
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Natalie Niskanen
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah E Taylor
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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164
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Pimentel GA, Guimarães TG, Silva GD, Scaff M. Case Report: Neurodegenerative Diseases After Severe Acute Respiratory Syndrome Coronavirus 2 Infection, a Report of Three Cases: Creutzfeldt–Jakob Disease, Rapidly Progressive Alzheimer's Disease, and Frontotemporal Dementia. Front Neurol 2022; 13:731369. [PMID: 35197920 PMCID: PMC8858976 DOI: 10.3389/fneur.2022.731369] [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: 06/27/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and neurodegenerative diseases is yet to be fully clarified. Rapid worsening and even new-onset cases of those disorders have been reported in association with coronavirus disease 2019 (COVID-19). We describe three cases of neurodegenerative diseases in patients with SARS-CoV-2: a case of Creutzfeldt–Jakob disease during the COVID-19 acute phase, to our knowledge, is the second one described in the literature; a rapidly progressive Alzheimer's Disease; and a patient with frontotemporal dementia, and a quick decline of both cognitive and behavioral domains. This report suggests an association between SARS-CoV-2 infection and a higher probability of developing or accelerating neurodegenerative chronic neurologic conditions. We reinforce the need for a close cognitive follow-up in the aftermath of Sars-Cov2 infection.
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Affiliation(s)
- Gabriela Almeida Pimentel
- Hospital Sirio-Libanes and The University of São Paulo Medical School, Neurology, São Paulo, Brazil
- *Correspondence: Gabriela Almeida Pimentel
| | | | - Guilherme Diogo Silva
- Hospital Sirio-Libanes and The University of São Paulo Medical School, Neurology, São Paulo, Brazil
| | - Milberto Scaff
- Hospital Sirio-Libanes and Professor of The University of São Paulo Medical School, Neurology, São Paulo, Brazil
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165
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Kolesnyk M, Stepanova N. Post-COVID syndrome in dialysis patients and kidney transplant recipients. UKRAINIAN JOURNAL OF NEPHROLOGY AND DIALYSIS 2022:90-98. [DOI: 10.31450/ukrjnd.1(73).2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Abstract. Patients on maintenance dialysis treatment and kidney transplant recipients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-COVID syndrome compared to the general population. However, a detailed assessment of the causes, features, and clinical outcomes of the post-COVID syndrome in this patients’ cohort does not yet been established. In this review, we summarize published research on this issue to use these available data to predict the development, treatment and prevention of the post-COVID syndrome in dialysis patients and kidney transplant recipients.
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166
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Mu L, Jiang L, Chen J, Xiao M, Wang W, Liu P, Wu J. Serum Inflammatory Factors and Oxidative Stress Factors Are Associated With Increased Risk of Frailty and Cognitive Frailty in Patients With Cerebral Small Vessel Disease. Front Neurol 2022; 12:786277. [PMID: 35069415 PMCID: PMC8770428 DOI: 10.3389/fneur.2021.786277] [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: 10/08/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To study the correlation between serum inflammatory factors, oxidative stress factors and frailty, and cognitive frailty in patients with cerebral small vessel disease (CSVD). Methods: A total of 281 patients with CSVD were selected from Tianjin Huanhu Hospital and Inner Mongolia People's Hospital from March 2019 to March 2021. CSVD was diagnosed by MRI. The FRAIL scale was used to evaluate the frailty of patients. Patients with CSVD with frailty and MMSE score <27 were considered to have cognitive frailty. Patients with non-cognitive frailty were included in the control group. The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the cognitive function of patients with CSVD. The serum interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase 3 (MMP-3), superoxide dismutase (SOD), and malondialdehyde (MDA) of patients with CSVD were detected. The correlation between blood inflammatory factors and oxidative stress factors with the frailty and cognitive frailty patients of CSVD were analyzed. Univariate and multivariate logistic regression were used to analyze the correlation between cognitive frailty and CSVD. Results: Among the patients with CSVD selected in this study, female patients and older patients had a higher proportion of frailty (p < 0.001). In the Frail group, MoCA score and MMSE score were significantly lower than in the Pre-Frail and Robust groups, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were significantly higher than the Pre-Frail and Robust groups, and the differences were statistically significant (p < 0.05). Serum CRP, IL-6, TNF-α, MMP-3, and MDA levels in the Frail group were higher, but SOD levels were lower. The levels of serum CRP, IL-6, TNF-α, MMP-3, and MDA in patients with CSVD in the Cognitive Frailty group were significantly higher than those of the Control group, while the levels of SOD were significantly lower than those of the Control group, and the differences were significant (p < 0.001). The results of univariate and multivariate logistic regression analysis showed that CRP, TNF-α, MMP-3, and MDA levels were associated with cognitive frailty in patients with CSVD (p < 0.05). Conclusion: The increase of serum CRP, TNF-α, MMP-3, and MDA levels are significantly related to the increased risk of frailty and cognitive frailty in patients with CSVD.
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Affiliation(s)
- Lei Mu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Limin Jiang
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Juan Chen
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Mei Xiao
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Wei Wang
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Peipei Liu
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
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167
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Sonkar C, Hase V, Banerjee D, Kumar A, Kumar R, Jha HC. Post COVID-19 Complications, Adjunct Therapy Explored, And Steroidal After Effects. CAN J CHEM 2022. [DOI: 10.1139/cjc-2021-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For survivors of the COVID-19 disease, defeating the virus is just the beginning of a long road to recovery. The virus’s inducibility and catastrophic effects are distributed in multiple organs. The induction of cytokine storms in COVID-19 patients is due to the interaction of the SARS-CoV-2 virus and the host receptor, leading to various immunopathological consequences that might eventually lead to death. So far, it has hit tons of people across the world, but there is still no effective treatment. Patients facing the complications of COVID-19 after recovering have shown extensive clinical symptoms similar to previously circulating coronaviruses. Previous knowledge, and literature have opened up ways to treat this disease and manage post-COVID-19 complications, which poses a severe challenge to health system globally and may exacerbate the fragmentation of diseases. The use of steroids, as a treatment, showed various health problems and side-effects in COVID-19 patients. This review substantially discusses various post-COVID-19 complications observed, adjunctive therapies used along with common COVID-19treatment and spotlighted their side effects and consequences. This review provides latest literature on COVID-19 which emphasizes the subsequent complications in various organs, side-effects of drug, and alternative regimes that were used to treat COVID-19.
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Affiliation(s)
- Charu Sonkar
- Indian Institute of Technology Indore, 226957, Department of Biosciences and Biomedical Engineering, Indore, India, 452017
| | - Vaishnavi Hase
- Indian Institute of Technology Indore, 226957, Department of Biosciences and Biomedical Engineering, Indore, India
| | - Durba Banerjee
- School of Biotechnology (SOB), Greater Noida, Uttar Pradesh, India
| | - Awanish Kumar
- National Institute of Technology, 54702, Department of Biotechnology, Raipur, India
| | - Rajesh Kumar
- Indian Institute of Technology, 28692, Department of Physics, Dhanbad, India, 826004
| | - Hem C. Jha
- Indian Institute of Technology Indore, 226957, Department of Biosciences & Biomedical Engineering, Simrol-453552, Indore, India, 452017
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168
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Bungenberg J, Humkamp K, Hohenfeld C, Rust MI, Ermis U, Dreher M, Hartmann NK, Marx G, Binkofski F, Finke C, Schulz JB, Costa AS, Reetz K. Long COVID‐19: Objectifying most self‐reported neurological symptoms. Ann Clin Transl Neurol 2022; 9:141-154. [PMID: 35060361 PMCID: PMC8862437 DOI: 10.1002/acn3.51496] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives We aimed to objectify and compare persisting self‐reported symptoms in initially hospitalized and non‐hospitalized patients after infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) by applying clinical standardized measures. Methods We conducted a cross‐sectional study of adult patients with confirmed SARS‐CoV‐2 infection including medical history, neurological examination, blood markers, neuropsychological testing, patient‐reported outcome measures (PROMs), and brain magnetic resonance imaging (MRI). Results Fifty patients with persisting symptoms for at least 4 weeks were included and classified by initial hospitalization status. Median time from SARS‐CoV‐2 detection to investigation was 29.3 weeks (range 3.3–57.9). Although individual cognitive performance was generally within the normative range in both groups, mostly mild deficits were found in attention, executive functions, and memory. Hospitalized patients performed worse in global cognition, logical reasoning, and processes of verbal memory. In both groups, fatigue severity was associated with reduced performance in attention and psychomotor speed tasks (rs = −0.40, p < 0.05) and reduced quality of life (EQ5D, rs = 0.57, p < 0.001) and with more persisting symptoms (median 3 vs. 6, p < 0.01). PROMs identified fatigue, reduced sleep quality, and increased anxiety and depression in both groups but more pronounced in non‐hospitalized patients. Brain MRI revealed microbleeds exclusively in hospitalized patients (n = 5). Interpretation Regardless of initial COVID‐19 severity, an individuals' mental and physical health can be severely impaired in the long‐term limitedly objectified by clinical standard diagnostic with abnormalities primarily found in hospitalized patients. This needs to be considered when planning rehabilitation therapies and should give rise to new biomarker research.
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Affiliation(s)
- Julia Bungenberg
- Department of Neurology RWTH Aachen University Aachen Germany
- JARA Institute Molecular Neuroscience and Neuroimaging Forschungszentrum Jülich GmbH and RWTH Aachen University Aachen Germany
| | - Karen Humkamp
- Department of Neurology RWTH Aachen University Aachen Germany
| | - Christian Hohenfeld
- Department of Neurology RWTH Aachen University Aachen Germany
- JARA Institute Molecular Neuroscience and Neuroimaging Forschungszentrum Jülich GmbH and RWTH Aachen University Aachen Germany
| | | | - Ummehan Ermis
- Department of Neurology RWTH Aachen University Aachen Germany
| | - Michael Dreher
- Department of Pneumonology and Internal Intensive Care Medicine RWTH University Hospital Aachen Germany
| | | | - Gernot Marx
- Department of Operative Intensive und Intermediate Care Medicine RWTH University Hospital Aachen Germany
| | - Ferdinand Binkofski
- Division of Clinical Cognitive Sciences, Department of Neurology RWTH Aachen University Aachen Germany
| | - Carsten Finke
- Department of Neurology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Jörg B. Schulz
- Department of Neurology RWTH Aachen University Aachen Germany
- JARA Institute Molecular Neuroscience and Neuroimaging Forschungszentrum Jülich GmbH and RWTH Aachen University Aachen Germany
| | - Ana Sofia Costa
- Department of Neurology RWTH Aachen University Aachen Germany
- JARA Institute Molecular Neuroscience and Neuroimaging Forschungszentrum Jülich GmbH and RWTH Aachen University Aachen Germany
| | - Kathrin Reetz
- Department of Neurology RWTH Aachen University Aachen Germany
- JARA Institute Molecular Neuroscience and Neuroimaging Forschungszentrum Jülich GmbH and RWTH Aachen University Aachen Germany
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169
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Zhao S, Shibata K, Hellyer PJ, Trender W, Manohar S, Hampshire A, Husain M. Rapid vigilance and episodic memory decrements in COVID-19 survivors. Brain Commun 2022; 4:fcab295. [PMID: 35128398 PMCID: PMC8807287 DOI: 10.1093/braincomms/fcab295] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
Recent studies indicate that COVID-19 infection can lead to serious neurological consequences in a small percentage of individuals. However, in the months following acute illness, many more suffer from fatigue, low motivation, disturbed mood, poor sleep and cognitive symptoms, colloquially referred to as 'brain fog'. But what about individuals who had asymptomatic to moderate COVID-19 and reported no concerns after recovering from COVID-19? Here, we examined a wide range of cognitive functions critical for daily life (including sustained attention, memory, motor control, planning, semantic reasoning, mental rotation and spatial-visual attention) in people who had previously suffered from COVID-19 but were not significantly different from a control group on self-reported fatigue, forgetfulness, sleep abnormality, motivation, depression, anxiety and personality profile. Reassuringly, COVID-19 survivors performed well in most abilities tested, including working memory, executive function, planning and mental rotation. However, they displayed significantly worse episodic memory (up to 6 months post-infection) and greater decline in vigilance with time on task (for up to 9 months). Overall, the results show that specific chronic cognitive changes following COVID-19 are evident on objective testing even amongst those who do not report a greater symptom burden. Importantly, in the sample tested here, these were not significantly different from normal after 6-9 months, demonstrating evidence of recovery over time.
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Affiliation(s)
- Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
| | - Kengo Shibata
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Peter J. Hellyer
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - William Trender
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
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170
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Ikeda T, Nishida K, Yoshimura M, Ishii R, Tsukuda B, Bunai T, Ouchi Y, Kikuchi M. Toward the Development of tES- Based Telemedicine System: Insights From the Digital Transformation and Neurophysiological Evidence. Front Psychiatry 2022; 13:782144. [PMID: 35898624 PMCID: PMC9309473 DOI: 10.3389/fpsyt.2022.782144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan.,United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Keiichiro Nishida
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Masafumi Yoshimura
- Department of Occupational Therapy, Faculty of Rehabilitation Kansai Medical University, Osaka, Japan.,Department of Neuropsychiatry, Kansai Medical University Medical Center, Osaka, Japan
| | - Ryouhei Ishii
- Occupational Therapy Major, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Banri Tsukuda
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mitsuru Kikuchi
- United Graduate School of Child Development, Osaka University, Osaka, Japan.,Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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171
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Damiano RF, Guedes BF, de Rocca CC, de Pádua Serafim A, Castro LHM, Munhoz CD, Nitrini R, Filho GB, Miguel EC, Lucchetti G, Forlenza O. Cognitive decline following acute viral infections: literature review and projections for post-COVID-19. Eur Arch Psychiatry Clin Neurosci 2022; 272:139-154. [PMID: 34173049 PMCID: PMC8231753 DOI: 10.1007/s00406-021-01286-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Recently, much attention has been drawn to the importance of the impact of infectious disease on human cognition. Several theories have been proposed, to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia, especially Alzheimer's disease. This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition, laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 (COVID-19). To reach this goal, we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID-19 and its impact on human cognition. Recent findings suggest probable short- and long-term COVID-19 impacts in cognition, even in asymptomatic individuals, which could be accounted for by direct and indirect pathways to brain dysfunction. Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID-19 pandemic as well as with other acute viral infections, to alleviate the cognitive sequelae of these infections around the world.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Bruno F. Guedes
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Cristiana Castanho de Rocca
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Antonio de Pádua Serafim
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | | | - Carolina Demarchi Munhoz
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Geraldo Busatto Filho
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Eurípedes Constantino Miguel
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Giancarlo Lucchetti
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Orestes Forlenza
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
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172
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Omar AKAE, Dahesh SMA, Ellakwa DES, Gomaa MK, Abdulsamad B, Hanafy R, Al Metwally HG, Mohammad RNEM, Badawy SS, El Saleh RM, Abdelhafiz ME, Gouda AM, Seada SAS, Amr MM, Asar Y, Alamrawy RG. Cognitive impairment in health care workers recovering from COVID-19 infection: a cross-sectional comparative study. MIDDLE EAST CURRENT PSYCHIATRY 2022; 29:79. [PMCID: PMC9573797 DOI: 10.1186/s43045-022-00245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 06/01/2023] Open
Abstract
Background The COVID-19 outbreak has infected people all over the world where many clinics are being constructed to diagnose and treat lingering symptoms or long COVID. Neurological and long-term cognitive consequences are very worrisome. Many of COVID-19’s neurological symptoms are likely the result of the body’s extensive immunological response to infection rather than the virus attacking the brain or nervous system directly. At the same time, the extent and type of COVID-19’s cognitive consequences are unknown. The goal of this study was to assess the cognitive functions of healthcare workers 2 weeks to 3 months after COVID-19 infection. Ninety-two healthcare workers participated in the study; 32 were post-COVID-19 cases, and 60 were healthy people (the comparison group). The cognitive functions of the participants were assessed using the Addenbrooke’s Cognitive Examination (ACE-III) test, which evaluated attention, memory, language, and visuospatial skills, as well as the Arabic version of the Patient Health Questionnaire Anxiety GAD-7 and Depression Assessments PHQ-9. Results The study revealed that there was a highly significant direct correlation between post-infection with COVID-19 and scores of both anxiety and depression and an inverse correlation in the case of attention and memory. On the other hand, there is no statistical effect of post-COVID-19 on verbal fluency, language scores, and visio-spatial abilities. Using multiple linear regression, there was a powerful significant decrease effect of post-COVID-19 on memory scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Also, there was a strong negative correlation post-COVID-19 on attention scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Conclusions The study showed a strong negative effect of post-COVID-19 on the attention and memory of patients. Furthermore, both anxiety and depression scores increased significantly among the post-COVID-19 patients.
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Affiliation(s)
| | - Salwa M. A. Dahesh
- Research Institute of Medical Entomology, General Organization for Teaching Hospitals and Institutes, Ministry of Health and Population, Cairo, Egypt
| | - Doha El-Sayed Ellakwa
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | | | | | - Rana Hanafy
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | | | | | | | | | | | - Yomna Asar
- Mamoura Psychiatric Hospital, General Secretariat of Mental Health and Addiction Treatment, Ministry of Health and Population, Alexandria, Egypt
- Neuroscience Research Master Candidate, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Roa Gamal Alamrawy
- Mamoura Psychiatric Hospital, General Secretariat of Mental Health and Addiction Treatment, Ministry of Health and Population, Alexandria, Egypt
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Matar-Khalil S. Neurocovid-19: efectos del COVID-19 en el cerebro. Rev Panam Salud Publica 2022; 46:e108. [PMID: 35875319 PMCID: PMC9299392 DOI: 10.26633/rpsp.2022.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/10/2022] [Indexed: 12/26/2022] Open
Abstract
En la pandemia por COVID-19 se han reportado efectos directos e indirectos sobre la salud mental, inclusive sintomatología neurológica, neuropsiquiátrica y neuropsicológica con posibles efectos a largo plazo, y se sospecha que en los próximos años podría haber un aumento de las tasas de incidencia de trastornos neurodegenerativos a nivel mundial. El objetivo de este artículo es revisar la información más actualizada sobre el daño cerebral asociado al COVID-19 y su sintomatología neuropsiquiátrica. Los mecanismos exactos del daño cerebral aún no se han esclarecido, y se requiere continuar con investigaciones longitudinales e internacionales —inclusive estudios que incluyan variables epidemiológicas, clínicas y diagnósticas— para definirlos y establecer su implicación en la salud mental, así como sus consecuencias a largo plazo.
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Long-term consequences of COVID-19 on cognitive functioning up to 6 months after discharge: role of depression and impact on quality of life. Eur Arch Psychiatry Clin Neurosci 2022; 272:773-782. [PMID: 34698871 PMCID: PMC8546751 DOI: 10.1007/s00406-021-01346-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023]
Abstract
Neurologic and psychiatric symptoms have been reported in the months following the infection with COVID-19. A low-grade inflammation has been associated both with depression and cognitive symptoms, suggesting a link between these disorders. The aim of the study is to investigate cognitive functioning 6 months following hospital discharge for COVID-19, the impact of depression, and the consequences on quality of life. Ninety-two COVID-19 survivors evaluated at 1-month follow-up, 122 evaluated at 3 months and 98 evaluated at 6 months performed neuropsychological and psychiatric evaluations and were compared with a healthy comparison group (HC) of 165 subjects and 165 patients with major depression (MDD). Cognitive performances were adjusted for age, sex, and education. Seventy-nine percent of COVID-19 survivors at 1 month and 75% at 3- and 6-month follow-up showed cognitive impairment in at least one cognitive function. No significant difference in cognitive performances was observed between 1-, 3-, and 6-months follow-up. COVID-19 patients performed worse than HC but better than MDD in psychomotor coordination and speed of information processing. No difference between COVID-19 survivors and MDD was observed for verbal fluency, and executive functions, which were lower than in HC. Finally, COVID-19 survivors performed the same as HC in working memory and verbal memory. The factor that most affected cognitive performance was depressive psychopathology which, in turn, interact with cognitive functions in determining quality of life. Our results confirm that COVID-19 sequelae include signs of cognitive impairment which persist up to 6 months after hospital discharge and affect quality of life.
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Damiano RF, Caruso MJG, Cincoto AV, de Almeida Rocca CC, de Pádua Serafim A, Bacchi P, Guedes BF, Brunoni AR, Pan PM, Nitrini R, Beach S, Fricchione G, Busatto G, Miguel EC, Forlenza OV. Post-COVID-19 psychiatric and cognitive morbidity: Preliminary findings from a Brazilian cohort study. Gen Hosp Psychiatry 2022; 75:38-45. [PMID: 35134702 PMCID: PMC8734055 DOI: 10.1016/j.genhosppsych.2022.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19. METHOD 425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the 'Least Absolute Shrinkage and Selection Operator' (LASSO) method. RESULTS Diagnoses of 'depression', 'generalized anxiety disorder' and 'post-traumatic stress disorder' were established respectively in 8%, 15.5% and 13.6% of the sample. After pandemic onset (i.e., within the previous year), the prevalence of 'depression' and 'generalized anxiety disorder' were 2.56% and 8.14%, respectively. Memory decline was subjectively reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. CONCLUSIONS This is the first study to access rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe forms of COVID-19 using standardized measures. As a key finding, there was no significant association between clinical severity in the acute-phase of SARS-CoV-2 infection and the neuropsychiatric impairment 6 to 9 months thereafter.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil.
| | - Maria Julia Guimarães Caruso
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Alissom Vitti Cincoto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Antonio de Pádua Serafim
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Pedro Bacchi
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - André R. Brunoni
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil,Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Departamento e Instituto de Psiquiatria, Laboratory of Neurosciences (LIM-27), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Scott Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
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Molina JD, Rodrigo Holgado I, Juanes González A, Combarro Ripoll CE, Lora Pablos D, Rubio G, Alonso J, Rivas-Clemente FPJ. Neuropsychological Symptom Identification and Classification in the Hospitalized COVID-19 Patients During the First Wave of the Pandemic in a Front-Line Spanish Tertiary Hospital. Front Psychiatry 2022; 13:838239. [PMID: 35308888 PMCID: PMC8924474 DOI: 10.3389/fpsyt.2022.838239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Studies specifically designed to determine the profile of psychiatric symptoms among COVID-19 patients are limited and based on case series, self-report questionnaires, and surveys. The objective of the study was to identify and classify the neuropsychological symptoms of hospitalized COVID-19 patients during the first wave of the pandemic in one of the most important front-line tertiary hospitals from Spain, and to analyze its correlation with diagnosed mental disorders, as well as to explore potential risk factors associated with mental health problems. This observational, cohort study involved data from COVID-19 patients at the University Hospital 12 de Octubre (Madrid, Spain) from February to May 2020. First, patients underwent a semistructured phone interview (screening phase), based on the Mini International Neuropsychiatric Interview (MINI). Then the confirmation of the diagnosis (confirmation phase) was performed in patients who reported a mental disorder development or worsening. A factorial analysis was performed to identify groups of symptoms. A tetrachoric matrix was created, and factorial analysis, by a principal component analysis, was employed upon it. Factors showing values >1.0 were selected, and a varimax rotation was applied to these factors. Symptoms most frequently identified in patients were anosmia/ageusia (54.6%), cognitive complaints (50.3%), worry/nervousness (43.8%), slowing down (36.2%), and sadness (35.4%). Four factors were identified after the screening phase. The first ("anxiety/depression") and second ("executive dysfunction") factors explained 45.4 and 11.5% of the variance, respectively. Women, age between 50 and 60 years, duration in the hospital (more than 13 days), and psychiatric history showed significant higher levels (number of symptoms) in the factors. This study reports the factor structure of the psychiatric symptoms developed by patients with a confirmed diagnosis of SARS-CoV2 during the first wave of the COVID-19. Three item domains (anxiety, depression, and posttraumatic stress disorder symptoms) were loaded together on one factor, whereas sleep disturbance stood up as a separate factor. Interestingly, the item anosmia/ageusia was not captured by any factor. In conclusion, an increase in neuropsychiatric morbidity is expected in the upcoming months and years. Therefore, screening for early symptoms is the first step to prevent mental health problems associated with this pandemic.
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Affiliation(s)
- Juan D Molina
- Centro de Investigación Biomédica en Red (CIBER) Salud Mental, Madrid, Spain.,Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain.,Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Irene Rodrigo Holgado
- Clinic Psychologist, COVID-19 Assistance Project, Psychotherapy Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Alba Juanes González
- Psychiatrist, COVID-19 Assistance Project, 12 de Octubre University Hospital, Madrid, Spain
| | | | - David Lora Pablos
- Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain.,CIBER de Epidemiología y Salud Pública, Madrid, Spain.,Faculty of Statistics, Complutense University of Madrid, Madrid, Spain
| | - Gabriel Rubio
- Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain.,Department of Psychiatry, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Addictive Disorders Network, Redes Temáticas de Investigación Cooperativa (RETICS) (Thematic Networks of Cooperative Research in Health), Carlos III Health Institute, Ministerio de Ciencia e Innovación (MICINN) and Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| | - Jordi Alonso
- Institut Municipal D'Investigacio Medica (IMIM)-Hospital del Mar Medical Research Institute, Pompeu Fabra University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)-CIBER en Epidemiología y Salud Pública, Madrid, Spain
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Elhiny R, Al-Jumaili AA, Yawuz MJ. OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:404-413. [PMID: 35881153 PMCID: PMC9384593 DOI: 10.1093/ijpp/riac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022]
Abstract
Objectives Methods Key findings Conclusion
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Affiliation(s)
- Rehab Elhiny
- Clinical Pharmacy Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Ali Azeez Al-Jumaili
- Correspondence: Ali Azeez Al-Jumaili, University of Baghdad College of Pharmacy, Bab Al Muadham, Baghdad 10047, Iraq; The University of Iowa, Iowa City, IA, USA; and UC Davis School of Medicine/PHS Department, USA.
| | - Mohammed Jamal Yawuz
- Clinical Pharmacy Department, College of Pharmacy, University of Baghdad, Baghdad, Iraq
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Tavares-Júnior JWL, Oliveira DN, da Silva JBS, Feitosa WLQ, Sousa AVM, Cunha LCV, Gaspar SDB, Gomes CMP, de Oliveira LLB, Moreira-Nunes CA, Montenegro RC, Sobreira-Neto MA, Braga-Neto P. Long-covid cognitive impairment: Cognitive assessment and apolipoprotein E (APOE) genotyping correlation in a Brazilian cohort. Front Psychiatry 2022; 13:947583. [PMID: 36046159 PMCID: PMC9423011 DOI: 10.3389/fpsyt.2022.947583] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Few studies have objectively evaluated cognitive deficits after the acute phase of COVID-19 disease. Moreover, the role of apolipoprotein E (APOE) genotypes in cognitive decline in patients with COVID-19 has not been evaluated yet. METHODS This cross-sectional study was conducted in confirmed cases of COVID-19 patients with neurological symptoms that persisted for more than 3 months from the onset. We determined APOE genotypes. RESULTS The final sample consisted of 141 patients. The most frequent APOE genotype was E3/E3 (N = 95; 67.3%). In total, 93 patients (65.9%) had memory impairment symptoms as the main complaint, objectively confirmed through screening tests in 25 patients (17.7%). Patients with cognitive impairment had a lower frequency of anosmia than the normal and subjective cognitive decline (SCD) groups (p = 0.005). In addition, depression was recurrent in the cognitive impairment group and the SCD group (p = 0.046). Cognitive impairment was significantly more frequent in hospitalized patients and those with a lower education level. Cognitive status was not associated with APOE genotypes. DISCUSSION Hospitalized patients had more severe infection with a greater possibility of systemic complications, greater inflammatory response, and prolonged hospitalization, which could impact cognitive performance. Cognitive impairment in patients with COVID-19 does not necessarily involve specific APOE polymorphisms. However, psychiatric disorders may also be responsible for cognitive complaints. Cognitive complaints are frequent in patients with COVID-19, even after the acute phase of the disease and in mild cases. Hospitalized participants and depressed patients may have a higher risk of cognitive impairment. APOE genotypes or haplotypes may not significantly play a role in COVID-19 cognitive impairment.
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Affiliation(s)
| | - Danilo Nunes Oliveira
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Jean Breno Silveira da Silva
- Drug Research and Development Center (NPDM), Pharmacogenetics Laboratory, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Werbety Lucas Queiroz Feitosa
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Artur Victor Menezes Sousa
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Letícia Chaves Vieira Cunha
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | | | | | - Laís Lacerda Brasil de Oliveira
- Drug Research and Development Center (NPDM), Pharmacogenetics Laboratory, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Caroline Aquino Moreira-Nunes
- Drug Research and Development Center (NPDM), Pharmacogenetics Laboratory, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Raquel Carvalho Montenegro
- Drug Research and Development Center (NPDM), Pharmacogenetics Laboratory, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Manoel Alves Sobreira-Neto
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Pedro Braga-Neto
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil.,Center of Health Sciences, State University of Ceará, Fortaleza, CE, Brazil
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Rota S, Boura I, Wan YM, Lazcano-Ocampo C, Rodriguez-Violante M, Antonini A, Chaudhuri KR. Spotlight on non-motor symptoms and Covid-19. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:103-133. [PMID: 36208897 PMCID: PMC9270874 DOI: 10.1016/bs.irn.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Coronavirus Disease 2019 (Covid-19) pandemic has profoundly affected the quality of life (QoL) and health of the general population globally over the past 2 years, with a clear impact on people with Parkinson's Disease (PwP, PD). Non-motor symptoms have been widely acknowledged to hold a vital part in the clinical spectrum of PD, and, although often underrecognized, they significantly contribute to patients' and their caregivers' QoL. Up to now, there have been numerous reports of newly emerging or acutely deteriorating non-motor symptoms in PwP who had been infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), while some of these symptoms, like fatigue, pain, depression, anxiety and cognitive impairment, have also been identified as part of the long-COVID syndrome due to their persistent nature. The subjacent mechanisms, mediating the appearance or progression of non-motor symptoms in the context of Covid-19, although probably multifactorial in origin, remain largely unknown. Such mechanisms might be, at least partly, related solely to the viral infection per se or the lifestyle changes imposed during the pandemic, as many of the non-motor symptoms seem to be prevalent even among Covid-19 patients without PD. Here, we summarize the available evidence and implications of Covid-19 in non-motor PD symptoms in the acute and chronic, if applicable, phase of the infection, with a special reference on studies of PwP.
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Manera MR, Fiabane E, Pain D, Aiello EN, Radici A, Ottonello M, Padovani M, Wilson BA, Fish J, Pistarini C. Clinical features and cognitive sequelae in COVID-19: a retrospective study on N=152 patients. Neurol Sci 2022; 43:45-50. [PMID: 34779965 PMCID: PMC8591589 DOI: 10.1007/s10072-021-05744-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The novel human coronavirus (SARS-CoV-2) shows neurotropism and systemically affects the central nervous system (CNS). Cognitive deficits have been indeed reported as both short- and long-term sequelae of SARS-CoV-2 infection. However, the association between these disturbances and background/disease-related clinical features remains elusive. This work aimed at exploring how post-infective cognitive status relates to clinical/treatment outcomes by controlling for premorbid/current risk factors for cognitive deficits. METHODS Cognitive measures (Mini-Mental State Examination, MMSE) of N=152 COVID-19 patient were retrospectively assessed in relation to disease severity, intensive care unit (ICU) admission, steroidal treatment, and occurrence of other viral/bacterial infections by controlling for remote/recent/COVID-19-related risk factors for cognitive deficits (at-risk vs. not-at-risk: Neuro+ vs. Neuro-). RESULTS Descriptively, impaired MMSE performances were highly prevalent in mild-to-moderate patients (26.3%). ICU-admitted patients made less errors (p=.021) on the MMSE than those not admitted when partialling out risk factors and age-the latter negatively influencing performances. When addressing Neuro- patients only, steroidal treatment appears to improve MMSE scores among those suffering from other infections (p=.025). DISCUSSION Cognitive sequelae of COVID-19 are likely to arise from a complex interplay between background/clinical premorbid features and disease-related/interventional procedures and outcomes. Mild-to-moderate patients requiring assistive ventilation who however are not admitted to an ICU are more likely to suffer from cognitive deficits-despite their etiology remaining elusive.
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Affiliation(s)
- Marina Rita Manera
- Istituti Clinici Scientifici Maugeri, IRCCS, Psychology Unit of Pavia Institute, Pavia, Italy
| | - Elena Fiabane
- Istituti Clinici Scientifici Maugeri, Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Genoa, Italy
| | - Debora Pain
- Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alice Radici
- Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - Marcella Ottonello
- Istituti Clinici Scientifici Maugeri, Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Genoa, Italy
| | - Mariacristina Padovani
- Istituti Clinici Scientifici Maugeri, IRCCS, Psychology Unit of Pavia Institute, Pavia, Italy
| | - Barbara Ann Wilson
- Department of Clinical Neuropsychology & Clinical Health Psychology, St George’s University, London, UK
| | - Jessica Fish
- Institute of Health and Wellbeing, University Of Glasgow, Glasgow, UK
| | - Caterina Pistarini
- Istituti Clinici Scientifici Maugeri, IRCCS, Department of Neurorehabilitation of Pavia Institute, Pavia, Italy
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Ferrando SJ, Dornbush R, Lynch S, Shahar S, Klepacz L, Karmen CL, Chen D, Lobo SA, Lerman D. Neuropsychological, medical and psychiatric findings after recovery from acute COVID-19: A cross-sectional study. J Acad Consult Liaison Psychiatry 2022; 63:474-484. [PMID: 35085824 PMCID: PMC8786396 DOI: 10.1016/j.jaclp.2022.01.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023]
Abstract
Background Objective Methods Results Conclusion
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182
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Citicoline and COVID-19-Related Cognitive and Other Neurologic Complications. Brain Sci 2021; 12:brainsci12010059. [PMID: 35053804 PMCID: PMC8782421 DOI: 10.3390/brainsci12010059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023] Open
Abstract
With growing concerns about COVID-19’s hyperinflammatory condition and its potentially damaging impact on the neurovascular system, there is a need to consider potential treatment options for managing short- and long-term effects on neurological complications, especially cognitive function. While maintaining adequate structure and function of phospholipid in brain cells, citicoline, identical to the natural metabolite phospholipid phosphatidylcholine precursor, can contribute to a variety of neurological diseases and hypothetically toward post-COVID-19 cognitive effects. In this review, we comprehensively describe in detail the potential citicoline mechanisms as adjunctive therapy and prevention of COVID-19-related cognitive decline and other neurologic complications through citicoline properties of anti-inflammation, anti-viral, neuroprotection, neurorestorative, and acetylcholine neurotransmitter synthesis, and provide a recommendation for future clinical trials.
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183
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Del Brutto OH, Rumbea DA, Recalde BY, Mera RM. Cognitive sequelae of long COVID may not be permanent: A prospective study. Eur J Neurol 2021; 29:1218-1221. [PMID: 34918425 DOI: 10.1111/ene.15215] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive decline is a recognized manifestation of long COVID, even among patients who experience mild disease. However, there is no evidence regarding the length of cognitive decline in these patients. This study aimed to assess whether COVID-19-related cognitive decline is a permanent deficit or if it improves over time. METHODS Cognitive performance was evaluated by means of the Montreal Cognitive Assessment (MoCA) in COVID-19 survivors and noninfected individuals. All study participants had four cognitive evaluations, two of them before the pandemic and the other two, 6 and 18 months after the initial SARS-CoV-2 outbreak infection in the village. Linear mixed effects models for longitudinal data were fitted to assess differences in cognitive performance across COVID-19 survivors and noninfected individuals. RESULTS The study included 78 participants, 50 with history of mild COVID-19 and 28 without. There was a significant-likely age-related-decline in MoCA scores between the two prepandemic tests (β = -1.53, 95% confidence interval [CI] = -2.14 to -0.92, p < 0.001), which did not differ across individuals who later developed COVID-19 when compared to noninfected individuals. Six months after infection, only COVID-19 survivors had a significant decline in MoCA scores (β = -1.37, 95% CI = -2.14 to -0.61, p < 0.001), which reversed after 1 additional year of follow-up (β = 0.66, 95% CI = -0.11 to 1.42, p = 0.092). No differences were noticed among noninfected individuals when both postpandemic MoCA scores were compared. CONCLUSIONS Study results suggest that long COVID-related cognitive decline may spontaneously improve over time.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, South San Francisco, California, USA
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184
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Fine JS, Ambrose AF, Didehbani N, Fleming TK, Glashan L, Longo M, Merlino A, Ng R, Nora G, Rolin S, Silver JK, Terzic CM, Verduzco Gutierrez M, Sampsel S. Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Cognitive Symptoms in Patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC). PM R 2021; 14:96-111. [PMID: 34902226 DOI: 10.1002/pmrj.12745] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | - Talya K Fleming
- JFK Johnson Rehabilitation Institute at Hackensack Meridian Health
| | | | | | | | - Rowena Ng
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine
| | | | - Summer Rolin
- University of Texas Health Science Center at San Antonio- Rehabilitation Medicine
| | - Julie K Silver
- Harvard Medical School, Spaulding Rehabilitation Hospital
| | - Carmen M Terzic
- Rehabilitation Medicine Research Center, Mayo Clinic Rochester
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185
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Abstract
The second year of the COVID-19 (Coronavirus Disease 2019) pandemic has seen the need to identify and assess the long-term consequences of a SARS-CoV-2 (Severe acute respiratory syndrome coronavirus-2) infection on an individual's, including adequate cognitive functioning. This review is attempting to highlight the current understanding of the various direct and indirect mechanisms of nervous system damage, describing the causality of similar symptoms following SARS-CoV-2 infection. This understanding is essential to establish the long-term consequences from the disease (including the potential for increased risk of dementia in some cases) and to identify means of preventing or ameliorating the brain damage. There is urgent need for research to better understand the pathogenesis of neurological disturbances in COVID-19, some of which have probably been covert and the prevalence of which may be considerably underestimated. Neuropsychiatric monitoring follow-up of COVID-19 patients will be important in determining the extent and prevalence of long-term neurological and psychiatric consequences of COVID-19. Early intervention for emerging these problems will be critical for improving quality of life for many COVID-19 survivors.
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Affiliation(s)
- M A Khoreva
- Altai State Medical University, Barnaul, Russia
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186
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Jaywant A, Vanderlind WM, Alexopoulos GS, Fridman CB, Perlis RH, Gunning FM. Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology 2021; 46:2235-2240. [PMID: 33589778 PMCID: PMC7884062 DOI: 10.1038/s41386-021-00978-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation. Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - W Michael Vanderlind
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US
| | - Chaya B Fridman
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - Roy H Perlis
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, US
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US.
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US.
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US.
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187
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Altuna M, Sánchez-Saudinós MB, Lleó A. Cognitive symptoms after COVID-19. NEUROLOGY PERSPECTIVES 2021; 1:S16-S24. [PMID: 38620975 PMCID: PMC8669718 DOI: 10.1016/j.neurop.2021.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
Introduction SARS-CoV-2 infection frequently causes neurological symptoms. Cognitive alterations are among the most frequent symptoms, and may persist beyond the acute phase of infection. Methods We conducted a narrative review of the literature. Results Hospitalised patients, and especially critically ill patients, are at greater risk of developing cognitive symptoms. Post-COVID-19 cognitive symptoms, unlike those associated with other viral illnesses, have been observed in patients with mild infection, and present some atypical features. Cognitive symptoms may last longer in COVID-19 than in other infectious processes, and more frequently affect young people. Post-COVID-19 cognitive symptoms share common features with those described in chronic fatigue syndrome, including a similar profile with affective symptoms. Brief screening tests for cognitive impairment present suboptimal diagnostic performance, and standardised criteria are needed to ensure correct diagnosis.Post-COVID-19 cognitive impairment can have a significant impact on the patient's quality of life and functional independence, regardless of other post-COVID-19 symptoms. Currently, no specific treatments have been approved for post-COVID-19 cognitive impairment, although cognitive stimulation may be useful in some patients. Conclusions Post-COVID-19 cognitive symptoms are common and are often associated with other systemic symptoms. Neuropsychological evaluation may be useful for diagnosis and to quantify their severity and long-term prognosis. Detailed, and individualised assessment of cognitive impairment may enable the design of treatment plans.
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Affiliation(s)
- M Altuna
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau - Universitat Autònoma de Barcelona, Barcelona, Spain
- Centre of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Mª B Sánchez-Saudinós
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau - Universitat Autònoma de Barcelona, Barcelona, Spain
- Centre of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - A Lleó
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau - Universitat Autònoma de Barcelona, Barcelona, Spain
- Centre of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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188
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Laudanski K, Hajj J, Restrepo M, Siddiq K, Okeke T, Rader DJ. Dynamic Changes in Central and Peripheral Neuro-Injury vs. Neuroprotective Serum Markers in COVID-19 Are Modulated by Different Types of Anti-Viral Treatments but Do Not Affect the Incidence of Late and Early Strokes. Biomedicines 2021; 9:1791. [PMID: 34944606 PMCID: PMC8698659 DOI: 10.3390/biomedicines9121791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023] Open
Abstract
The balance between neurodegeneration, neuroinflammation, neuroprotection, and COVID-19-directed therapy may underly the heterogeneity of SARS-CoV-2's neurological outcomes. A total of 105 patients hospitalized with a diagnosis of COVID-19 had serum collected over a 6 month period to assess neuroinflammatory (MIF, CCL23, MCP-1), neuro-injury (NFL, NCAM-1), neurodegenerative (KLK6, τ, phospho τ, amyloids, TDP43, YKL40), and neuroprotective (clusterin, fetuin, TREM-2) proteins. These were compared to markers of nonspecific inflammatory responses (IL-6, D-dimer, CRP) and of the overall viral burden (spike protein). Data regarding treatment (steroids, convalescent plasma, remdasavir), pre-existing conditions, and incidences of strokes were collected. Amyloid β42, TDP43, NF-L, and KLK6 serum levels declined 2-3 days post-admission, yet recovered to admission baseline levels by 7 days. YKL-40 and NCAM-1 levels remained elevated over time, with clusters of differential responses identified among TREM-2, TDP43, and YKL40. Fetuin was elevated after the onset of COVID-19 while TREM-2 initially declined before significantly increasing over time. MIF serum level was increased 3-7 days after admission. Ferritin correlated with TDP-43 and KLK6. No treatment with remdesivir coincided with elevations in Amyloid-β40. A lack of convalescent plasma resulted in increased NCAM-1 and total tau, and steroidal treatments did not significantly affect any markers. A total of 11 incidences of stroke were registered up to six months after initial admission for COVID-19. Elevated D-dimer, platelet counts, IL-6, and leukopenia were observed. Variable MIF serum levels differentiated patients with CVA from those who did not have a stroke during the acute phase of COVID-19. This study demonstrated concomitant and opposite changes in neurodegenerative and neuroprotective markers persisting well into recovery.
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Affiliation(s)
- Krzysztof Laudanski
- The Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jihane Hajj
- School of Nursing, Widener University, Philadelphia, PA 19013, USA;
| | - Mariana Restrepo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Kumal Siddiq
- College of Arts and Sciences, Drexel University, Philadelphia, PA 19104, USA;
| | - Tony Okeke
- School of Biomedical Engineering, Drexel University, Philadelphia, PA 19104, USA;
| | - Daniel J. Rader
- Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, USA;
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189
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Matias-Guiu JA, Delgado-Alonso C, Yus M, Polidura C, Gómez-Ruiz N, Valles-Salgado M, Ortega-Madueño I, Cabrera-Martín MN, Matias-Guiu J. "Brain Fog" by COVID-19 or Alzheimer's Disease? A Case Report. Front Psychol 2021; 12:724022. [PMID: 34803804 PMCID: PMC8599288 DOI: 10.3389/fpsyg.2021.724022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Cognitive symptoms after COVID-19 have been increasingly recognized several months after the acute infection and have been designated as “brain fog.” We report a patient with cognitive symptoms that started immediately after COVID-19, in which cerebrospinal fluid biomarkers were highly suggestive of Alzheimer’s disease. Our case highlights the need to examine patients with cognitive symptoms following COVID-19 comprehensively. A detailed assessment combining clinical, cognitive, and biomarker studies may help disentangle the underlying mechanisms associated with cognitive dysfunction in each case. The investigation of neurodegenerative processes in an early stage, especially in older patients, is probably warranted.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Institute of Neuroscience, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Institute of Neuroscience, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Miguel Yus
- Department of Radiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Carmen Polidura
- Department of Radiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Natividad Gómez-Ruiz
- Department of Radiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Institute of Neuroscience, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Isabel Ortega-Madueño
- Institute of Laboratory Medicine, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - María Nieves Cabrera-Martín
- Department of Nuclear Medicine, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Institute of Neuroscience, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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190
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Widmann CN, Wieberneit M, Bieler L, Bernsen S, Gräfenkämper R, Brosseron F, Schmeel C, Tacik P, Skowasch D, Radbruch A, Heneka MT. Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study. JMIR Res Protoc 2021; 10:e30259. [PMID: 34559059 PMCID: PMC8589042 DOI: 10.2196/30259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID) DERR1-10.2196/30259
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Affiliation(s)
- Catherine N Widmann
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Michelle Wieberneit
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Luzie Bieler
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Sarah Bernsen
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Robin Gräfenkämper
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany.,Department of Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | | | - Carsten Schmeel
- Department of Neuroradiology, University of Bonn Medical Center, Bonn, Germany
| | - Pawel Tacik
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Dirk Skowasch
- Department of Cardiology, Pneumology and Angiology, Internal Medicine II, University of Bonn Medical Center, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University of Bonn Medical Center, Bonn, Germany
| | - Michael T Heneka
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
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191
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Larsson AC, Palstam A, Persson HC. Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19: A Descriptive Cross-Sectional Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111600. [PMID: 34770113 PMCID: PMC8582899 DOI: 10.3390/ijerph182111600] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022]
Abstract
An estimated 14–20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.
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Affiliation(s)
- Alexandra C. Larsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
- Correspondence:
| | - Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Neuro Science, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Hanna C. Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
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192
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Kverno K. Brain Fog: A Bit of Clarity Regarding Etiology, Prognosis, and Treatment. J Psychosoc Nurs Ment Health Serv 2021; 59:9-13. [PMID: 34714198 DOI: 10.3928/02793695-20211013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brain fog is a lay term used to describe cognitive difficulties. Brain fog can be a response to lack of sleep, poor nutrition, medications, or drugs; however, the term is often used to describe the subjective experience of neuroinflammation. Chronic low-level inflammation is the most detrimental to the mind and body. The purpose of the current article is to examine the mechanisms, associated symptoms, and treatments for neuroinflammation and brain fog. The state of the science is lacking evidence for specific treatments targeting the mechanisms/pathways of neuroinflammation for precision-based care, yet there are pharmacological and nonpharmacological interventions that can reduce inflammation and improve functioning. [Journal of Psychosocial Nursing and Mental Health Services, 59(11), 9-13.].
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193
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Asadi-Pooya AA, Akbari A, Emami A, Lotfi M, Rostamihosseinkhani M, Nemati H, Barzegar Z, Kabiri M, Zeraatpisheh Z, Farjoud-Kouhanjani M, Jafari A, Sasannia F, Ashrafi S, Nazeri M, Nasiri S, Shahisavandi M. Long COVID syndrome-associated brain fog. J Med Virol 2021; 94:979-984. [PMID: 34672377 PMCID: PMC8662118 DOI: 10.1002/jmv.27404] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
We investigated the frequency of brain fog in a large cohort of patients with documented coronavirus disease-2019 (COVID-19) who have survived the illness. We also scrutinized the potential risk factors associated with the development of brain fog. Adult patients (18-55 years of age), who were referred to the healthcare facilities anywhere in Fars province from February 19, 2020 to November 20, 2020 were included. All patients had a confirmed COVID-19 diagnosis. In a phone call, at least 3 months after their discharge from the hospital, we obtained their current information. A questionnaire was specifically designed for data collection. In total, 2696 patients had the inclusion criteria; 1680 (62.3%) people reported long COVID syndrome (LCS). LCS-associated brain fog was reported by 194 (7.2%) patients. Female sex (odds ratio [OR]: 1.4), respiratory problems at the onset (OR: 1.9), and intensive care unit (ICU) admission (OR: 1.7) were significantly associated with reporting chronic post-COVID "brain fog" by the patients. In this large population-based study, we report that chronic post-COVID "brain fog" has significant associations with sex (female), respiratory symptoms at the onset, and the severity of the illness (ICU admission).
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ali Akbari
- Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Emami
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamid Nemati
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kabiri
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zeraatpisheh
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Anahita Jafari
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Sasannia
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shayan Ashrafi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Nazeri
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Nasiri
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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194
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Bonizzato S, Ghiggia A, Ferraro F, Galante E. Cognitive, behavioral, and psychological manifestations of COVID-19 in post-acute rehabilitation setting: preliminary data of an observational study. Neurol Sci 2021; 43:51-58. [PMID: 34642823 PMCID: PMC8510572 DOI: 10.1007/s10072-021-05653-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/06/2021] [Indexed: 01/07/2023]
Abstract
Psychological, emotional, and behavioral domains could be altered in COVID-19 patients and measurement of variables within these domains seems to be mandatory. Neuropsychological assessment could detect possible cognitive impairment caused by COVID-19 and the choice of appropriate tools is an important question. Aim of this exploratory study was to verify the effectiveness of an assessment model for patients with COVID-19. Twelve patients were enrolled and tested with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Anxiety and Depression Short Scale (AD-R), and the Neuropsychiatry Inventory (NPI), at the time of their entrance (T0) and discharge (T1) from a rehabilitative unit. Moreover, a follow-up evaluation after 3 months (T2) has been conducted on eight patients. Results showed that at baseline (T0), 58.3% of the patients reported a score below cut-off at MMSE and 50% at MoCA. Although a significant amelioration was found only in NPI scores, a qualitative improvement has been detected at all tests, except for MoCA scores, in the T0-T1 trend analysis. A one-way repeated measures analysis of variance showed a significant variation in AD-R depression score, considering the three-assessment time (T0, T1, and T2). The evaluation and tracking over time of the impact of COVID-19 on cognitive, psychological, and behavioral domains has relevant implications for rehabilitation and long-term assistance needs planning. The choice of assessment tools should consider patients vulnerability and match the best compromise among briefness, sensitivity, and specificity.
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Affiliation(s)
- Silvia Bonizzato
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy
| | - Ada Ghiggia
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy.
| | - Francesco Ferraro
- Neuro-Motor Rehabilitation Unit, Neuroscience Department, Azienda Socio Sanitaria Territoriale Di Mantova, via XXV Aprile 71, Bozzolo, Mantova, Italy
| | - Emanuela Galante
- Neuro-Motor Rehabilitation Unit, Neuroscience Department, Azienda Socio Sanitaria Territoriale Di Mantova, via XXV Aprile 71, Bozzolo, Mantova, Italy
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195
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Dąbrowska E, Galińska-Skok B, Waszkiewicz N. Depressive and Neurocognitive Disorders in the Context of the Inflammatory Background of COVID-19. Life (Basel) 2021; 11:1056. [PMID: 34685427 PMCID: PMC8541562 DOI: 10.3390/life11101056] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023] Open
Abstract
The dysfunctional effects of the coronavirus disease 2019 (COVID-19) infection on the nervous system are established. The manifestation of neuropsychiatric symptoms during and after infection is influenced by the neuroinvasive and neurotrophic properties of SARS-CoV-2 as well as strong inflammation characterised by a specific "cytokine storm". Research suggests that a strong immune response to a SARS-CoV-2 infection and psychological stressors related to the pandemic may cause chronic inflammatory processes in the body with elevated levels of inflammatory markers contributing to the intensification of neurodegenerative processes. It is suggested that neuroinflammation and associated central nervous system changes may significantly contribute to the etiopathogenesis of depressive disorders. In addition, symptoms after a COVID-19 infection may persist for up to several weeks after an acute infection as a post-COVID-19 syndrome. Moreover, previous knowledge indicates that among SSRI (selective serotonin reuptake inhibitor) group antidepressants, fluoxetine is a promising drug against COVID-19. In conclusion, further research, observation and broadening of the knowledge of the pathomechanism of a SARS-CoV-2 infection and the impact on potential complications are necessary. It is essential to continue research in order to assess the long-term neuropsychiatric effects in COVID-19 patients and to find new therapeutic strategies.
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Affiliation(s)
- Eliza Dąbrowska
- Department of Psychiatry, Medical University of Bialystok, pl. Brodowicza 1, 16-070 Choroszcz, Poland; (B.G.-S.); (N.W.)
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196
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Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19 - A systematic review. Brain Behav Immun 2021; 97:328-348. [PMID: 34339806 PMCID: PMC8363196 DOI: 10.1016/j.bbi.2021.07.018] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 12/12/2022] Open
Abstract
It has become evident that coronavirus disease 2019 (COVID-19) has a multi-organ pathology that includes the brain and nervous system. Several studies have also reported acute psychiatric symptoms in COVID-19 patients. An increasing number of studies are suggesting that psychiatric deficits may persist after recovery from the primary infection. In the current systematic review, we provide an overview of the available evidence and supply information on potential risk factors and underlying biological mechanisms behind such psychiatric sequelae. We performed a systematic search for psychiatric sequelae in COVID-19 patients using the databases PubMed and Embase. Included primary studies all contained information on the follow-up period and provided quantitative measures of mental health. The search was performed on June 4th 2021. 1725 unique studies were identified. Of these, 66 met the inclusion criteria and were included. Time to follow-up ranged from immediately after hospital discharge up to 7 months after discharge, and the number of participants spanned 3 to 266,586 participants. Forty studies reported anxiety and/or depression, 20 studies reported symptoms- or diagnoses of post-traumatic stress disorder (PTSD), 27 studies reported cognitive deficits, 32 articles found fatigue at follow-up, and sleep disturbances were found in 23 studies. Highlighted risk factors were disease severity, duration of symptoms, and female sex. One study showed brain abnormalities correlating with cognitive deficits, and several studies reported inflammatory markers to correlate with symptoms. Overall, the results from this review suggest that survivors of COVID-19 are at risk of psychiatric sequelae but that symptoms generally improve over time.
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Affiliation(s)
- Thor Mertz Schou
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Samia Joca
- Department of Biomedicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Cecilie Bay-Richter
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark.
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197
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Posillico CK. Three's Company: Neuroimmune activation, sex, and memory at the tripartite synapse. Brain Behav Immun Health 2021; 16:100326. [PMID: 34589812 PMCID: PMC8474433 DOI: 10.1016/j.bbih.2021.100326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022] Open
Abstract
The neuroimmune system is required for normal cognitive functions such as learning and memory in addition to its critical role in detecting and responding to invading pathogens and injury. Understanding the functional convergence of neurons, astrocytes, and microglia at the synapse, particularly in the hippocampus, is key to understanding the nuances of such diverse roles. In the healthy brain, communication between all three cells is important for regulating neuronal activation and synaptic plasticity mechanisms, and during neuroinflammation, the activity and functions of all three cells can produce and be modulated by inflammatory cytokines. An important remaining component to this system is the conclusive evidence of sex differences in hippocampal plasticity mechanisms, hormone modulation of synaptic plasticity, functional properties of hippocampal neurons, and in neuroimmune activation. Sex as a biological variable here is necessary to consider given sex differences in the prevalence of memory-related disorders such as Alzheimer's disease and Post-Traumatic Stress disorder, both of which present with neuroimmune dysregulation. To make meaningful progress towards a deeper understanding of sex biases in memory-related disease prevalence, I propose that the next chapter of psychoneuroimmune research must focus on the signal integration and transduction at the synapse between experience-dependent plasticity mechanisms, neuroimmune activation, and the influence of biological sex.
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198
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Grover S, Sahoo S, Mishra E, Gill KS, Mehra A, Nehra R, Suman A, Bhalla A, Puri GD. Fatigue, perceived stigma, self-reported cognitive deficits and psychological morbidity in patients recovered from COVID-19 infection. Asian J Psychiatr 2021; 64:102815. [PMID: 34455354 PMCID: PMC8379818 DOI: 10.1016/j.ajp.2021.102815] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few studies have highlighted multiple psychosocial and physical outcomes in patients with COVID-19 infection after recovery. However, the data from developing countries is limited. AIM To evaluate psychological morbidity, post-traumatic stress disorder (PTSD), fatigue, and perceived stigma among patients with COVID-19 after recovery from the acute phase of COVID-19 infection. METHODS In a cross-sectional online survey, 206 adult patients (age>18 years), recovered from COVID-19 infection completed the Patient Health Questionnaire-4 (PHQ-4), the Impact of Events Scale-Revised (IES-R), Fatigue Severity Scale (FSS), 4 items self-designed questionnaire evaluating cognitive deficits and self-designed questionnaire to evaluate perceived stigma. Additionally, they completed the information about demographic and clinical information. RESULTS The prevalence of anxiety, depressive symptoms, and PTSD in the study sample was 24.8 %, 23.8 %, and 30 % respectively. About three-fifths of the participants (61.2 %) had at least one fatigue symptom as per the FSS with the mean FSS score being 32.10 ± 15.28. About one-fourth of the participants (23.7 %) reported "feeling confused and always feeling mentally foggy", and 38 % of patients reported experiencing at least one cognitive problem. The level of felt stigma related to self was seen in 31.1 %, 20 % reported stigma related to family, and 50 % reported stigma in relation to neighbors and society. Those reporting higher PTSD scores had higher anxiety and depressive scores, reported more fatigue and stigma, and had a higher level of cognitive deficits. A higher fatigue score was also associated with higher anxiety, depression, and cognitive deficits. CONCLUSIONS Our study reveals that a significant proportion of patients after recovery from COVID-19 experience psychological morbidities, fatigue, cognitive problems, and stigma. Efforts should be made to take care of these issues in routine post-COVID follow-up care.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Eepsita Mishra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kanwarbir Singh Gill
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aarzoo Suman
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia & Critical Care, Post Graduate Institute of Medical, Education and Research, Chandigarh, 160012, India
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199
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One-Year Functional, Cognitive, and Psychological Outcomes Following the Use of Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019: A Prospective Study. Crit Care Explor 2021; 3:e0537. [PMID: 34589715 PMCID: PMC8437214 DOI: 10.1097/cce.0000000000000537] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To prospectively describe 1-year outcomes, with a focus on functional outcome, cognitive outcome, and the burden of anxiety, depression, and post-traumatic stress disorder, in coronavirus disease 2019 patients managed with extracorporeal membrane oxygenation. Design Prospective case series. Setting Tertiary extracorporeal membrane oxygenation center in the United States. Patients Adult coronavirus disease 2019 acute respiratory distress syndrome patients managed with extracorporeal membrane oxygenation March 1, 2020, to July 31, 2020. Interventions Baseline variables, treatment measures, and short-term outcomes were obtained from the medical record. Survivors were interviewed by telephone, a year following the index intensive care admission. Functional outcome was assessed using the modified Rankin Scale and the World Health Organization Disability Assessment Scale 2.0. Cognitive status was assessed with the 5-minute Montreal Cognitive Assessment. The Hospital Anxiety and Depression Scale was used to screen for anxiety and depression. Screening for post-traumatic stress disorder was performed with the Posttraumatic Stress Disorder Checklist 5 instrument. Measurements and Main Results Twenty-three patients were managed with extracorporeal membrane oxygenation, 14 (61%) survived to hospital discharge. Thirteen (57%) were alive at 1 year. One patient was dependent on mechanical ventilation, another intermittently required supplemental oxygen at 1 year. The median modified Rankin Scale score was 2 (interquartile range, 1-2), median World Health Organization Disability Assessment Scale 2.0 impairment score was 21% (interquartile range, 6-42%). Six of 12 previously employed individuals (50%) had returned to work, and 10 of 12 (83%) were entirely independent in activities of daily living. The median Montreal Cognitive Assessment score was 14 (interquartile range, 13-14). Of 10 patients assessed with Hospital Anxiety and Depression Scale, 4 (40%) screened positive for depression and 6 (60%) for anxiety. Four of 10 (40%) screened positive for post-traumatic stress disorder. Conclusions Functional impairment was common a year following the use of extracorporeal membrane oxygenation in coronavirus disease 2019, although the majority achieved independence in daily living and about half returned to work. Long-term anxiety, depression, and post-traumatic stress disorder were common, but cognitive impairment was not.
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200
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Backman L, Möller MC, Thelin EP, Dahlgren D, Deboussard C, Östlund G, Lindau M. Monthlong Intubated Patient with Life-Threatening COVID-19 and Cerebral Microbleeds Suffers Only Mild Cognitive Sequelae at 8-Month Follow-up: A Case Report. Arch Clin Neuropsychol 2021; 37:531-543. [PMID: 34530432 PMCID: PMC8500017 DOI: 10.1093/arclin/acab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To elaborate on possible cognitive sequelae related to COVID-19, associated cerebrovascular injuries as well as the general consequences from intensive care. COVID-19 is known to have several, serious CNS-related consequences, but neuropsychological studies of severe COVID-19 are still rare. METHODS M., a 45-year-old man, who survived a severe COVID-19 disease course including Acute Respiratory Distress Syndrome (ARDS), cerebral microbleeds, and 35 days of mechanical ventilation, is described. We elaborate on M's recovery and rehabilitation process from onset to the 8-month follow-up. The cognitive functions were evaluated with a comprehensive screening battery at 4 weeks after extubation and at the 8-month follow-up. RESULTS Following extubation, M. was delirious, reported visual hallucinations, and had severe sleeping difficulties. At about 3 months after COVID-19 onset, M. showed mild to moderate deficits on tests measuring processing speed, working memory, and attention. At assessments at 8 months, M. performed better, with results above average on tests measuring learning, memory, word fluency, and visuospatial functions. Minor deficits were still found regarding logical reasoning, attention, executive functioning, and processing speed. There were no lingering psychiatric symptoms. While M. had returned to a part-time job, he was not able to resume previous work-tasks. CONCLUSION This case-study demonstrates possible cognitive deficits after severe COVID-19 and emphasizes the need of a neuropsychological follow-up, with tests sensitive to minor deficits. The main findings of this report provide some support that the long-term prognosis for cognition in severe COVID-19 may be hopeful.
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Affiliation(s)
- Linda Backman
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Marika C Möller
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Eric P Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Dahlgren
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Deboussard
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Östlund
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Maria Lindau
- Department of Psychology, Stockholm University, Stockholm, Sweden
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