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Almeria M, Cejudo JC, Deus J, Krupinski J. Neurocognitive and Neuropsychiatric Sequelae in Long COVID-19 Infection. Brain Sci 2024; 14:604. [PMID: 38928604 DOI: 10.3390/brainsci14060604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: To characterize the cognitive profile of long COVID-19 subjects and its possible association with clinical symptoms, emotional disturbance, biomarkers, and disease severity. Methods: We performed a single-center cross-sectional cohort study. Subjects between 20 and 60 years old with confirmed COVID-19 infection were included. The assessment was performed 6 months following hospital or ambulatory discharge. Excluded were those with prior neurocognitive impairment and severe neurological/neuropsychiatric disorders. Demographic and laboratory data were extracted from medical records. Results: Altogether, 108 participants were included, 64 were male (59.25%), and the mean age was 49.10 years. The patients were classified into four groups: non-hospitalized (NH, n = 10), hospitalized without Intensive Care Unit (ICU) or oxygen therapy (HOSPI, n = 21), hospitalized without ICU but with oxygen therapy (OXY, n = 56), and ICU (ICU, n = 21) patients. In total, 38 (35.18%) reported Subjective Cognitive Complaints (SCC). No differences were found considering illness severity between groups. Females had more persistent clinical symptoms and SCC than males. Persistent dyspnea and headache were associated with higher scores in anxiety and depression. Persistent fatigue, anxiety, and depression were associated with worse overall cognition. Conclusions: No cognitive impairment was found regarding the severity of post-COVID-19 infection. SCC was not associated with a worse cognitive performance, but with higher anxiety and depression. Persistent clinical symptoms were frequent independent of illness severity. Fatigue, anxiety, and depression were linked to poorer cognitive function. Tests for attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients.
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Affiliation(s)
- Marta Almeria
- Department of Neurology, Hospital Universitari MútuaTerrassa, 08221 Terrassa, Spain
| | - Juan Carlos Cejudo
- Cognitive Impairment and Dementia Unit, Hospital Sagrat Cor, Hermanas Hospitalarias, 08760 Martorell, Spain
| | - Joan Deus
- Clinical and Health Department, Psychology Faculty, Autonomous University of Barcelona, 08193 Bellaterra, Spain
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain
| | - Jerzy Krupinski
- Department of Neurology, Hospital Universitari MútuaTerrassa, 08221 Terrassa, Spain
- Faculty of Science and Engineering, Department of Life Sciences John Dalton Building, Manchester Metropolitan University, Manchester M15 6BH, UK
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Austin TA, Thomas ML, Lu M, Hodges CB, Darowski ES, Bergmans R, Parr S, Pickell D, Catazaro M, Lantrip C, Twamley EW. Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection. Neuropsychol Rev 2024:10.1007/s11065-024-09642-6. [PMID: 38862725 DOI: 10.1007/s11065-024-09642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.
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Affiliation(s)
- Tara A Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA.
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Colorado Springs, Fort Collins, USA
| | - Min Lu
- University of Miami, Miami, FL, USA
| | - Cooper B Hodges
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | | | - Rachel Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Parr
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Delaney Pickell
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
| | - Mikayla Catazaro
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Crystal Lantrip
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Carnes-Vendrell A, Piñol-Ripoll G, Ariza M, Cano N, Segura B, Junque C, Béjar J, Barrue C, Garolera M. Poor sleep quality may trigger cognitive deficits after recovery from COVID-19. Front Psychol 2024; 15:1382875. [PMID: 38860054 PMCID: PMC11164190 DOI: 10.3389/fpsyg.2024.1382875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/29/2024] [Indexed: 06/12/2024] Open
Abstract
Objective In the present study, we aimed to assess the cognition of post-COVID-19 condition (PCC) participants in relation to their subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and to analyse possible moderators of this effect, such as quality of life (European Quality of Life-5 Dimensions, EQ-5D), fatigue (Chadler Fatigue Questionnaire, CFQ), cognitive reserve (Cognitive Reserve Questionnaire, CRC), and subjective cognitive complaints (Memory Failures of Everyday Questionnaire, MFE-30). Methods We included 373 individuals with PCC and 126 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575) who were assessed with a comprehensive neuropsychological battery and various questionnaires. Results We found that PCC participants with poor sleep quality had a 4.3% greater risk of immediate verbal memory deficits than those with good sleep quality, as indicated by the greater odds ratio (OR) of 1.043 and confidence interval (CI) of 1.023-1.063. Additionally, their risk of immediate verbal memory disorders was multiplied by 2.4 when their EQ-5D score was low (OR 0.33; CI 0.145-0.748), and they had a lower risk of delayed visual memory deficits with a greater CRC (OR 0.963; CI 0.929-0.999). With respect to processing speed, PCC participants with poor sleep quality had a 6.7% greater risk of deficits as the MFE increased (OR 1.059; CI 1.024-1.096), and the risk of slowed processing speed tripled with a lower EQ-5D (OR 0.021; CI 0.003-0.141). Conclusion These results indicate that poor subjective sleep quality is a potential trigger for cognitive deficits. Therapeutic strategies to maximize sleep quality could include reducing sleep disturbances and perhaps cognitive impairment in PCC individuals.
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Affiliation(s)
- A. Carnes-Vendrell
- Cognitive Disorders Unit, Cognition and Behavior Study Group, Hospital Universitari Santa Maria, Lleida, Spain
| | - G. Piñol-Ripoll
- Cognitive Disorders Unit, Cognition and Behavior Study Group, Hospital Universitari Santa Maria, Lleida, Spain
| | - M. Ariza
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - N. Cano
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - B. Segura
- Medical Psychology Unit, Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - C. Junque
- Medical Psychology Unit, Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J. Béjar
- Faculty of Informatics of Barcelona (FIB), Polytechnic University of Catalonia, Barcelona, Spain
| | - C. Barrue
- Faculty of Informatics of Barcelona (FIB), Polytechnic University of Catalonia, Barcelona, Spain
| | - M. Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
- Neuropsychology Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
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Dacosta-Aguayo R, Puig J, Lamonja-Vicente N, Carmona-Cervelló M, León-Gómez BB, Monté-Rubio G, López-Linfante VM, Zamora-Putin V, Montero-Alia P, Chacon C, Bielsa J, Moreno-Gabriel E, Garcia-Sierra R, Pachón A, Costa A, Mataró M, Prado JG, Martinez-Cáceres E, Mateu L, Massanella M, Violán C, Torán-Monserrat P. Reduced Cortical Thickness Correlates of Cognitive Dysfunction in Post-COVID-19 Condition: Insights from a Long-Term Follow-up. AJNR Am J Neuroradiol 2024; 45:647-654. [PMID: 38575319 DOI: 10.3174/ajnr.a8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data on long-term neuroimaging findings from individuals who have developed the post-coronavirus 2019 (COVID-19) condition. Only 2 studies have investigated the correlations between cognitive assessment results and structural MR imaging in this population. This study aimed to elucidate the long-term cognitive outcomes of participants with the post-COVID-19 condition and to correlate these cognitive findings with structural MR imaging data in the post-COVID-19 condition. MATERIALS AND METHODS A cohort of 53 participants with the post-COVID-19 condition underwent 3T brain MR imaging with T1 and FLAIR sequences obtained a median of 1.8 years after Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection. A comprehensive neuropsychological battery was used to assess several cognitive domains in the same individuals. Correlations between cognitive domains and whole-brain voxel-based morphometry were performed. Different ROIs from FreeSurfer were used to perform the same correlations with other neuroimaging features. RESULTS According to the Frascati criteria, more than one-half of the participants had deficits in the attentional (55%, n = 29) and executive (59%, n = 31) domains, while 40% (n = 21) had impairment in the memory domain. Only 1 participant (1.89%) showed problems in the visuospatial and visuoconstructive domains. We observed that reduced cortical thickness in the left parahippocampal region (t(48) = 2.28, P = .03) and the right caudal-middle-frontal region (t(48) = 2.20, P = .03) was positively correlated with the memory domain. CONCLUSIONS Our findings suggest that cognitive impairment in individuals with the post-COVID-19 condition is associated with long-term alterations in the structure of the brain. These macrostructural changes may provide insight into the nature of cognitive symptoms.
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Affiliation(s)
- Rosalia Dacosta-Aguayo
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Department of Clinical Psychology and Psychobiology (R.D.-A., M.M.), University of Barcelona, Barcelona, Spain. Institut de Neurociències, University of Barcelona, Barcelona, Spain. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Puig
- Comparative Medicine and Bioimaging Center (J.P., G.M.-R.), Germans Trias i Pujol Research Institute, Badalona, Spain
- Department of Radiology (IDI) (J.P.), IDIBGI Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Noemi Lamonja-Vicente
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Meritxell Carmona-Cervelló
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Brenda Biaani León-Gómez
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Gemma Monté-Rubio
- Comparative Medicine and Bioimaging Center (J.P., G.M.-R.), Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Victor M López-Linfante
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Palau-Solità Healthcare Centre (V.M.L.-L., V.Z.-P.), Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
- Department of Medicine (V.M.L.-L., E.M.-C.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
| | - Valeria Zamora-Putin
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Palau-Solità Healthcare Centre (V.M.L.-L., V.Z.-P.), Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
| | - Pilar Montero-Alia
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Carla Chacon
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (C.C., C.V.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol; Barcelona, Spain. Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Jofre Bielsa
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Eduard Moreno-Gabriel
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Department of Social Psychology (E.M.-G.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
| | - Rosa Garcia-Sierra
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Nursing Department, Faculty of Medicine (R.G.-S.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Pachón
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Anna Costa
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology (R.D.-A., M.M.), University of Barcelona, Barcelona, Spain. Institut de Neurociències, University of Barcelona, Barcelona, Spain. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Julia G Prado
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (J.G.P., M.M.), Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
| | - Eva Martinez-Cáceres
- Department of Medicine (V.M.L.-L., E.M.-C.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Immunology Department (E.M.-C.), FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Immunology Division, Laboratori Clinic Metropolitana Nord (E.M.-C.), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Mateu
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Infectious Diseases Department (L.M.), Fight against AIDS Foundation (FLS), Germans Trias I Pujol Hospital, Can Ruti Campus, Badalona, Spain
- Red Española de Investigación en Covid Persisitente (L.M., M.M.), European Innovation and Collaboration Programme, Badalona, Spain
| | - Marta Massanella
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (J.G.P., M.M.), Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Red Española de Investigación en Covid Persisitente (L.M., M.M.), European Innovation and Collaboration Programme, Badalona, Spain
| | - Concepción Violán
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (C.C., C.V.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol; Barcelona, Spain. Germans Trias i Pujol Research Institute, Badalona, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Red de Investigación en Cronicidad (C.V.), Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autónoma de Barcelona (C.V.), Bellaterra, Spain
| | - Pere Torán-Monserrat
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Department of Medicine (P.T.-M.), Faculty of Medicine, Universitat de Girona, Girona, Spain
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Goldenberg DL. How to understand the overlap of long COVID, chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia and irritable bowel syndromes. Semin Arthritis Rheum 2024; 67:152455. [PMID: 38761526 DOI: 10.1016/j.semarthrit.2024.152455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
Long COVID should be limited to patients with multiple, persistent symptoms not related to well-defined organ damage. Once redefined, a focused review of long COVID demonstrates striking similarity to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), fibromyalgia (FM) and irritable bowel syndrome (IBS). Research in long COVID has revealed similar findings to those noted in CFS/ME and FM, characterized by central nervous system organ dysfunction. Long COVID, like CFS/ME, FM and IBS, is best understood as a bidirectional mind-body, neuroimmune illness.
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Affiliation(s)
- Don L Goldenberg
- Emeritus Professor of Medicine, Tufts University School of Medicine, United States; Adjunct Faculty, Departments of Medicine and Nursing, Oregon Health Sciences University, United States.
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6
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van der Feltz-Cornelis C, Turk F, Sweetman J, Khunti K, Gabbay M, Shepherd J, Montgomery H, Strain WD, Lip GYH, Wootton D, Watkins CL, Cuthbertson DJ, Williams N, Banerjee A. Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 88:10-22. [PMID: 38447388 DOI: 10.1016/j.genhosppsych.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions. METHODS Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection. FINDINGS 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000). CONCLUSIONS Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
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Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom; Hull York Medical School, (HYMS), University of York, York, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | - Fidan Turk
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Jessie Shepherd
- Department of Health Sciences, University of York, York, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, University College London, London, United Kingdom
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Clinical and Biomedical Science and College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Leigh Watkins
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom; School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nefyn Williams
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
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7
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Deodato M, Qualizza C, Martini M, Mazzari L, Furlanis G, Buoite Stella A, Manganotti P. Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study. Neurol Sci 2024; 45:1325-1333. [PMID: 38191766 DOI: 10.1007/s10072-023-07268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment. METHODS AND MATERIALS Ten non-hospitalized adults with reported fatigue and "brain fog" symptoms after COVID (7/10 females, 50 years, range 41-58) who participated in 20 sessions of a 1-h "dual-task" training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56 years, range 43-65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability. RESULTS The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (- 15.9 s, 95% CI 7.6-24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93-0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups. CONCLUSION The preliminary results from this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery after COVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Caterina Qualizza
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Laura Mazzari
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy.
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
| | - Paolo Manganotti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
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8
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Carnes-Vendrell A, Piñol-Ripoll G, Ariza M, Cano N, Segura B, Junque C, Béjar J, Barrue C, Garolera M. Sleep quality in individuals with post-COVID-19 condition: Relation with emotional, cognitive and functional variables. Brain Behav Immun Health 2024; 35:100721. [PMID: 38269302 PMCID: PMC10806261 DOI: 10.1016/j.bbih.2023.100721] [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: 09/25/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
The study aimed to assess sleep quality in PCC patients and its predictors by analysing its relationship with emotional, cognitive and functional variables, as well as possible differences based on COVID-19 severity. We included 368 individuals with PCC and 123 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575). We assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety (Generalized Anxiety Disorder, GAD-7), depression (Patient Health Questionnaire, PHQ-9), global cognition (Montreal Cognitive Assessment, MoCA), everyday memory failures (Memory Failures of Everyday Questionnaire, MFE-30), fatigue (Chadler Fatigue Questionnaire, CFQ), quality of life (European Quality of Life-5 Dimensions, EQ-5D), and physical activity levels (International Physical Activity Questionnaire, IPAQ). 203 were nonhospitalized, 83 were hospitalized and 82 were admitted to the intensive care unit (ICU). We found statistically significant differences in the PSQI total score between the PCC and HC groups (p < 0.0001), but there were no differences among the PCC groups. In the multiple linear regressions, the PHQ-9 score was a predictor of poor sleep quality for mild PCC patients (p = 0.003); GAD-7 (p = 0.032) and EQ-5D (p = 0.011) scores were predictors of poor sleep quality in the hospitalized PCC group; and GAD-7 (p = 0.045) and IPAQ (p = 0.005) scores were predictors of poor sleep quality in the group of ICU-PCC. These results indicate that worse sleep quality is related to higher levels of depression and anxiety, worse quality of life and less physical activity. Therapeutic strategies should focus on these factors to have a positive impact on the quality of sleep.
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Affiliation(s)
- A. Carnes-Vendrell
- Cognitive Disorders Unit, Cognition and Behavior Study Group, Hospital Universitari Santa Maria, Lleida, Spain
| | - G. Piñol-Ripoll
- Cognitive Disorders Unit, Cognition and Behavior Study Group, Hospital Universitari Santa Maria, Lleida, Spain
| | - M. Ariza
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - N. Cano
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, Barcelona, Spain
| | - B. Segura
- Medical Psychology Unit, Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - C. Junque
- Medical Psychology Unit, Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J. Béjar
- Faculty of Informatics of Barcelona (FIB), Polytechnic University of Catalonia, Barcelona, Spain
| | - C. Barrue
- Faculty of Informatics of Barcelona (FIB), Polytechnic University of Catalonia, Barcelona, Spain
| | - M. Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain
- Neuropsychology Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
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9
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Ariza M, Béjar J, Barrué C, Cano N, Segura B, Cortés CU, Junqué C, Garolera M. Cognitive reserve, depressive symptoms, obesity, and change in employment status predict mental processing speed and executive function after COVID-19. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01748-x. [PMID: 38285245 DOI: 10.1007/s00406-023-01748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
The risk factors for post-COVID-19 cognitive impairment have been poorly described. This study aimed to identify the sociodemographic, clinical, and lifestyle characteristics that characterize a group of post-COVID-19 condition (PCC) participants with neuropsychological impairment. The study sample included 426 participants with PCC who underwent a neurobehavioral evaluation. We selected seven mental speed processing and executive function variables to obtain a data-driven partition. Clustering algorithms were applied, including K-means, bisecting K-means, and Gaussian mixture models. Different machine learning algorithms were then used to obtain a classifier able to separate the two clusters according to the demographic, clinical, emotional, and lifestyle variables, including logistic regression with least absolute shrinkage and selection operator (LASSO) (L1) and Ridge (L2) regularization, support vector machines (linear/quadratic/radial basis function kernels), and decision tree ensembles (random forest/gradient boosting trees). All clustering quality measures were in agreement in detecting only two clusters in the data based solely on cognitive performance. A model with four variables (cognitive reserve, depressive symptoms, obesity, and change in work situation) obtained with logistic regression with LASSO regularization was able to classify between good and poor cognitive performers with an accuracy and a weighted averaged precision of 72%, a recall of 73%, and an area under the curve of 0.72. PCC individuals with a lower cognitive reserve, more depressive symptoms, obesity, and a change in employment status were at greater risk for poor performance on tasks requiring mental processing speed and executive function. Study registration: www.ClinicalTrials.gov , identifier NCT05307575.
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Affiliation(s)
- Mar Ariza
- Grup de Recerca en Cervell, Cognició i Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Javier Béjar
- Departament de Ciències de la Computació, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain.
| | - Cristian Barrué
- Departament de Ciències de la Computació, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | - Neus Cano
- Grup de Recerca en Cervell, Cognició i Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, Spain
| | - Bàrbara Segura
- Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona (UB), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona (UB), Barcelona, Spain
| | - Claudio Ulises Cortés
- Departament de Ciències de la Computació, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | - Carme Junqué
- Unitat de Psicologia Mèdica, Departament de Medicina, Universitat de Barcelona (UB), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona (UB), Barcelona, Spain
| | - Maite Garolera
- Grup de Recerca en Cervell, Cognició i Conducta, Consorci Sanitari de Terrassa (CST), Terrassa, Spain.
- Neuropsychology Unit, Consorci Sanitari de Terrassa (CST), Terrassa, Spain.
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10
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Latifi A, Flegr J. Is recovery just the beginning? Persistent symptoms and health and performance deterioration in post-COVID-19, non-hospitalized university students-a cross-sectional study. Biol Methods Protoc 2023; 8:bpad037. [PMID: 38144461 PMCID: PMC10739555 DOI: 10.1093/biomethods/bpad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023] Open
Abstract
Many individuals experience persistent symptoms such as deteriorated physical and mental health, increased fatigue, and reduced cognitive performance months after recovering from coronavirus disease 2019 (COVID-19). There is limited data on the long-term trajectory and prevalence of these symptoms, especially in milder cases. Our study aimed to assess the persistent effects of COVID-19 on physical and mental health, fatigue, and cognitive performance in a cohort of 214 students, averaging 21.8 years of age. Of these, 148 had contracted COVID-19 but were not hospitalized, with the time since infection ranging from 1 to 39 months. We utilized a comprehensive panel of cognitive tests to measure intelligence, memory, and psychomotor skills, and a detailed anamnestic questionnaire to evaluate physical and mental health. While contracting COVID-19 did not significantly impact overall health and performance, it was associated with increased reports of fatigue. However, the reported severity of the disease had a pronounced negative influence on physical health, mental well-being, fatigue, and reaction time. Trends of improvement in physical and mental health, as well as error rate, were observed within the first 2 years post-infection. However, fatigue and reaction time showed a trend of deterioration. Beyond the 2-year mark, physical health and error rate continued to improve, while mental health began to deteriorate. Fatigue and reaction time continued to decline. Overall, our findings suggest that some effects of contracting COVID-19 can persist or even deteriorate over time, even in younger individuals who had mild cases that did not require hospitalization.
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Affiliation(s)
- Ashkan Latifi
- Department of Philosophy and History of Sciences, Faculty of Science, Laboratory of Evolutionary Biology, Charles University, Viničná 7, Prague 128 00, Czechia
| | - Jaroslav Flegr
- Department of Philosophy and History of Sciences, Faculty of Science, Laboratory of Evolutionary Biology, Charles University, Viničná 7, Prague 128 00, Czechia
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11
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Fernández-de-las-Peñas C, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Arias-Navalón JA, Martín-Guerrero JD, Pellicer-Valero OJ, Arendt-Nielsen L, Cigarán-Méndez M. Trajectory of post-COVID brain fog, memory loss, and concentration loss in previously hospitalized COVID-19 survivors: the LONG-COVID-EXP multicenter study. Front Hum Neurosci 2023; 17:1259660. [PMID: 38021227 PMCID: PMC10665893 DOI: 10.3389/fnhum.2023.1259660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aimed to apply Sankey plots and exponential bar plots for visualizing the trajectory of post-COVID brain fog, memory loss, and concentration loss in a cohort of previously hospitalized COVID-19 survivors. Methods A sample of 1,266 previously hospitalized patients due to COVID-19 during the first wave of the pandemic were assessed at 8.4 (T1), 13.2 (T2), and 18.3 (T3) months after hospital discharge. They were asked about the presence of the following self-reported cognitive symptoms: brain fog (defined as self-perception of sluggish or fuzzy thinking), memory loss (defined as self-perception of unusual forgetfulness), and concentration loss (defined as self-perception of not being able to maintain attention). We asked about symptoms that individuals had not experienced previously, and they attributed them to the acute infection. Clinical and hospitalization data were collected from hospital medical records. Results The Sankey plots revealed that the prevalence of post-COVID brain fog was 8.37% (n = 106) at T1, 4.7% (n = 60) at T2, and 5.1% (n = 65) at T3, whereas the prevalence of post-COVID memory loss was 14.9% (n = 189) at T1, 11.4% (n = 145) at T2, and 12.12% (n = 154) at T3. Finally, the prevalence of post-COVID concentration loss decreased from 6.86% (n = 87) at T1, to 4.78% (n = 60) at T2, and to 2.63% (n = 33) at T3. The recovery exponential curves show a decreasing trend, indicating that these post-COVID cognitive symptoms recovered in the following years after discharge. The regression models did not reveal any medical record data associated with post-COVID brain fog, memory loss, or concentration loss in the long term. Conclusion The use of Sankey plots shows a fluctuating evolution of post-COVID brain fog, memory loss, or concentration loss during the first years after the infection. In addition, exponential bar plots revealed a decrease in the prevalence of these symptoms during the first years after hospital discharge. No risk factors were identified in this cohort.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Ignacio Cancela-Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - José D. Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Valencia, Spain
- Valencian Graduate School and Research Network of Artificial Intelligence (ValgrAI), València, Spain
| | - Oscar J. Pellicer-Valero
- Image Processing Laboratory (IPL), Universitat de València, Parc Científic, Paterna, València, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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12
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Sekendiz Z, Clouston SAP, Morozova O, Carr MA, Fontana A, Mehta N, Ali A, Jiang E, Luft B. ASSESSMENT AND CHARACTERIZATION OF COVID-19 RELATED COGNITIVE DECLINE: RESULTS FROM A NATURAL EXPERIMENT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.06.23298101. [PMID: 37986906 PMCID: PMC10659478 DOI: 10.1101/2023.11.06.23298101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Cognitive impairment is the most common and disabling manifestation of post-acute sequelae of SARS-CoV-2. There is an urgent need for the application of more stringent methods for evaluating cognitive outcomes in research studies. Objective To determine whether cognitive decline emerges with the onset of COVID-19 and whether it is more pronounced in patients with Post-Acute Sequelae of SARS-CoV-2 or severe COVID-19. Methods This longitudinal cohort study compared the cognitive performance of 276 patients with COVID-19 to that of 217 controls across four neuroinflammation or vascular disease-sensitive domains of cognition using data collected both before and after the pandemic starting in 2015. Results The mean age of the COVID-19 group was 56.04±6.6 years, while that of the control group was 58.1±7.3 years. Longitudinal models indicated a significant decline in cognitive throughput ((β=-0.168, P=.001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. The effect sizes were large; the observed changes in throughput were equivalent to 10.6 years of normal aging and a 59.8% increase in the burden of mild cognitive impairment. Cognitive decline worsened with coronavirus disease 2019 severity and was concentrated in participants reporting post-acute sequelae of SARS-CoV-2. Conclusion COVID-19 was most likely associated with the observed cognitive decline, which was worse among patients with PASC or severe COVID-19. Monitoring patients with post-acute sequelae of SARS-CoV-2 for declines in the domains of processing speed and visual working memory and determining the long-term prognosis of this decline are therefore warranted.
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Affiliation(s)
- Zennur Sekendiz
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Sean A P Clouston
- Stony Brook University, Family, Population and Preventive Medicine, Program in Public Health
| | - Olga Morozova
- The University of Chicago, Department of Public Health Sciences
| | - Melissa A Carr
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Ashley Fontana
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Nikhil Mehta
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Alina Ali
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Eugene Jiang
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Benjamin Luft
- Stony Brook University, Department of Medicine-World Trade Center Health Program
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13
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Becker JH, Lin JJ, Twumasi A, Goswami R, Carnavali F, Stone K, Rivera-Mindt M, Kale MS, Naasan G, Festa JR, Wisnivesky JP. Greater executive dysfunction in patients post-COVID-19 compared to those not infected. Brain Behav Immun 2023; 114:111-117. [PMID: 37586567 DOI: 10.1016/j.bbi.2023.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND A number of patients post-coronavirus disease-19 (COVID-19) report cognitive impairment (CI), even months after acute infection. We aimed to assess if COVID-19 is associated with increased incidence of CI in comparison to controls. METHODS We analyzed data from the Mount Sinai Health System Post-COVID-19 Registry in New York City, a prospective cohort of patients post-COVID-19 ≥18 years of age and non-infected controls. CI was defined by scores ≥ 1.0 standard deviation below population norms, and was assessed using well-validated measures of attention, working memory, processing speed, executive functioning/cognitive flexibility, language, learning, and memory. Logistic regression models assessed odds for CI in each domain in patients post-COVID-19 vs. controls after adjusting for potential confounders. In exploratory analyses, we assessed odds for CI by site of acute COVID-19 care as a proxy for disease severity. FINDINGS 417 patients post-COVID-19 and 151 controls (mean age 49 years, 63% female, 21% Black, 17% Latinx) were included. In adjusted analyses, patients were significantly more likely than controls to have CI in executive functioning (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.03 to 4.67), particularly those treated in outpatient (OR: 2.22; 95% CI: 1.02 to 4.82) and inpatient hospital (OR: 3.59; 95% CI: 1.27 to 10.16) settings. There were no significant associations between CI in other domains and history of COVID-19 or site of acute care. INTERPRETATION Patients post-COVID-19 have greater odds of executive dysfunction, suggesting that focused cognitive screening may be prudent, even in those with mild to moderate disease. Studies should explore the pathophysiology and potential treatments for CI in this population. FUNDING This work was funded by the Icahn School of Medicine at Mount Sinai.
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Affiliation(s)
- Jacqueline H Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Akosua Twumasi
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Ruchir Goswami
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Fernando Carnavali
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Kimberly Stone
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Monica Rivera-Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Juan P Wisnivesky
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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14
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Vinuela-Navarro V, Goset J, Aldaba M, Mestre C, Rovira-Gay C, Cano N, Ariza M, Delàs B, Garolera M, Vilaseca M. Eye movements in patients with post-COVID condition. BIOMEDICAL OPTICS EXPRESS 2023; 14:3936-3949. [PMID: 37799689 PMCID: PMC10549724 DOI: 10.1364/boe.489037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 10/07/2023]
Abstract
Eye movement control is impaired in some neurological conditions, but the impact of COVID-19 on eye movements remains unknown. This study aims to investigate differences in oculomotor function and pupil response in individuals who suffer post-COVID-19 condition (PCC) with cognitive deficits. Saccades, smooth pursuit, fixation, vergence and pupillary response were recorded using an eye tracker. Eye movements and pupil response parameters were computed. Data from 16 controls, 38 COVID mild (home recovery) and 19 COVID severe (hospital admission) participants were analyzed. Saccadic latencies were shorter in controls (183 ± 54 ms) than in COVID mild (236 ± 83 ms) and COVID severe (227 ± 42 ms) participants (p = 0.017). Fixation stability was poorer in COVID mild participants (Bivariate Contour Ellipse Area of 0.80 ± 1.61°2 vs 0.36 ± 0.65 °2 for controls, p = 0.019), while percentage of pupil area reduction/enlargement was reduced in COVID severe participants (39.7 ± 12.7%/31.6 ± 12.7% compared to 51.7 ± 22.0%/49.1 ± 20.7% in controls, p < 0.015). The characteristics of oculomotor alterations found in PCC may be useful to understand different pathophysiologic mechanisms.
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Affiliation(s)
- Valldeflors Vinuela-Navarro
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Joan Goset
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Mikel Aldaba
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Clara Mestre
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Cristina Rovira-Gay
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Neus Cano
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Department de Ciències Bàsiques. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Mar Ariza
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Bàrbara Delàs
- Servei d’Oftalmologia. Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Maite Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Neuropsychology Unit, Hospital de Terrassa, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Meritxell Vilaseca
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
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