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Zifko U, Guendling K, Seet R, Kasper S. Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care. Front Pharmacol 2024; 15:1338235. [PMID: 38711990 PMCID: PMC11072190 DOI: 10.3389/fphar.2024.1338235] [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: 11/14/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction: Although post-COVID-19 syndrome (PCS) with cognitive impairment is increasingly encountered in primary care, evidence-based recommendations for its appropriate management are lacking. Methods: A systematic literature search evaluating the diagnosis and treatment of cognitive impairment associated with PCS was conducted. Practical recommendations for the management of PCS-associated cognitive impairment in primary care are summarized, based on an evaluation of pharmacological plausibility and clinical applications. Results: Currently, the pathology of cognitive impairment associated with PCS remains unclear with no high-quality data to support targeted interventions. Existing treatment approaches are directed towards symptom relief where counseling on the chronicity of the disease and regular reassessments at 4- to 8-week intervals is considered reasonable. Patients should be informed and encouraged to adopt a healthy lifestyle that centers around balanced nutrition and appropriate physical activities. They may also benefit from the intake of vitamins, micronutrients, and probiotics. The administration of Ginkgo biloba extract could offer a safe and potentially beneficial treatment option. Other non-pharmacological measures include physiotherapy, digitally supported cognitive training, and, if indicated, ergotherapy or speech therapy. In most patients, symptoms improve within 8 weeks. If serious, ambiguous, or when new symptoms occur, specialized diagnostic measures such as comprehensive neurocognitive testing or neuroimaging should be initiated. Very few patients would require inpatient rehabilitation. Conclusion: PCS with cognitive impairment is a debilitating condition that could affect daily functioning and reduce work productivity. Management in primary care should adopt a multidisciplinary approach, centering around physical, cognitive, and pharmacological therapies.
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Affiliation(s)
- Udo Zifko
- Rudolfinerhaus private clinic GmbH, Rudolfinerhaus, Vienna, Austria
| | | | - Raymond Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siegfried Kasper
- Center for Brain Research, Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
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2
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Merolla A, De Lorenzo R, Paolazzi G, Critelli S, Palladini M, Damanti S, Vitali G, Canti V, Cilla M, Martinenghi S, Falbo E, Ferrante M, Castellani J, Pacioni G, Magnaghi C, Fumagalli A, Mazza MG, Benedetti F, Rovere-Querini P. Micronized/ultramicronized palmitoylethanolamide improves depression and fatigue in coronavirus disease 2019 (COVID-19) survivors. Int Clin Psychopharmacol 2024:00004850-990000000-00130. [PMID: 38381905 DOI: 10.1097/yic.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Coronavirus disease 2019 (COVID-19) may lead to neuropsychiatric sequelae. Palmitoylethanolamide (PEA) is an anti-inflammatory and neuroprotective amide used in depressive syndromes. Here we investigate whether micronized/ultramicronized (m/um) PEA improves neuropsychiatric sequelae in COVID-19 survivors. Patients evaluated at our post-COVID-19 outpatient clinic between February and August 2021 and presenting neuropsychiatric manifestations (n = 98) were offered treatment with m/umPEA 600 mg twice daily for 3 months. Those accepting m/umPEA therapy (n = 57) were compared with those who did not (n = 41), in terms of depression, fatigue, chronic pain and subjective well-being, through validated scales administered pre- and posttreatment. The two groups did not differ in terms of demographics, comorbidities, psychiatric history, antidepressant therapy, acute COVID-19 severity and baseline neuropsychiatric status. Patients receiving m/umPEA showed a greater improvement in depression and fatigue (both P < 0.05). Conversely, no association was found with changes in chronic pain or subjective well-being. At multivariable logistic regression, m/umPEA predicted neuropsychiatric improvement independently of age, sex and baseline neuropsychiatric status. Worse pretreatment fatigue and subjective well-being identified those who most likely benefited from treatment. In conclusion, despite its retrospective nature, our study suggests that m/umPEA may improve depression and fatigue in COVID-19 survivors, justifying future research in this setting.
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Affiliation(s)
- Aurora Merolla
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Rebecca De Lorenzo
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Giacomo Paolazzi
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Sara Critelli
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Mariagrazia Palladini
- Unit of Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Hospital
| | - Sarah Damanti
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital
| | - Giordano Vitali
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
| | - Valentina Canti
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
| | - Marta Cilla
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
| | | | - Elisabetta Falbo
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Marica Ferrante
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Jacopo Castellani
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Giacomo Pacioni
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | | | - Anna Fumagalli
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
| | - Mario G Mazza
- School of Medicine and Surgery, Vita-Salute San Raffaele University
- Unit of Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Hospital
| | - Francesco Benedetti
- School of Medicine and Surgery, Vita-Salute San Raffaele University
- Unit of Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Hospital
| | - Patrizia Rovere-Querini
- Post-COVID-19 Outpatient Clinic, IRCCS San Raffaele Hospital
- School of Medicine and Surgery, Vita-Salute San Raffaele University
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ariza M, Cano N, Segura B, Bejar J, Barrué C, Cortés CU, Junqué C, Garolera M. Cognitive and emotional predictors of quality of life and functioning after COVID-19. Ann Clin Transl Neurol 2024; 11:302-320. [PMID: 38130039 PMCID: PMC10863915 DOI: 10.1002/acn3.51952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE A long-term decline in health-related quality of life (HRQoL) has been reported after coronavirus disease 2019 (COVID-19). Studies with people with persistent symptoms showed inconsistent outcomes. Cognition and emotion are important determinants in HRQoL, but few studies have examined their prognostic significance for HRQoL and functionality in post-COVID patients with persisting symptoms. We aimed to describe QoL, HRQoL, and functioning in individuals post-COVID with varying COVID-19 severities and to investigate the predictive value of cognitive and emotional variables for QoL, HRQoL, and functioning. METHODS In total, 492 participants (398 post-COVID and 124 healthy controls) underwent a neurobehavioral examination that included assessments of cognition, mood, QoL/HRQoL (WHOQOL-BREF, EQ-5D), and functioning (WHODAS-II). Analysis of covariance and linear regression models were used to study intergroup differences and the relationship between cognitive and emotional variables and QoL and functioning. RESULTS The Physical and Psychological dimensions of WHOQoL, EQ-5D, and WHODAS Cognition, Mobility, Life Activities, and Participation dimensions were significantly lower in post-COVID groups compared with a control group. Regression models explaining 23.9%-53.9% of variance were obtained for the WHOQoL-BREF dimensions and EQ-5D, with depressive symptoms, post-COVID symptoms, employment status, income, and mental speed processing as main predictors. For the WHODAS, models explaining 17%-60.2% of the variance were obtained. Fatigue, depressive symptoms, mental speed processing, and post-COVID symptoms were the main predictors. INTERPRETATION QoL/HRQoL and functioning after COVID-19 in individuals with persistent symptoms were lower than in non-affected persons. Depressive symptoms, fatigue, and slower mental processing speed were predictors of lower QoL/HRQoL and functioning.
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Affiliation(s)
- Mar Ariza
- Grup de Recerca en Cervell, Cognició i ConductaConsorci Sanitari de Terrassa (CST)TerrassaSpain
- Unitat de Psicologia Mèdica, Departament de MedicinaUniversitat de Barcelona (UB)BarcelonaSpain
| | - Neus Cano
- Grup de Recerca en Cervell, Cognició i ConductaConsorci Sanitari de Terrassa (CST)TerrassaSpain
- Departament de Ciències BàsiquesUniversitat Internacional de Catalunya (UIC)Sant Cugat del VallèsSpain
| | - Bàrbara Segura
- Unitat de Psicologia Mèdica, Departament de MedicinaUniversitat de Barcelona (UB)BarcelonaSpain
- Institut de NeurociènciesUniversitat de Barcelona (UB)BarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Javier Bejar
- Departament de Ciències de la ComputacióUniversitat Politècnica de Catalunya‐BarcelonaTechBarcelonaSpain
| | - Cristian Barrué
- Departament de Ciències de la ComputacióUniversitat Politècnica de Catalunya‐BarcelonaTechBarcelonaSpain
| | - Claudio Ulises Cortés
- Departament de Ciències de la ComputacióUniversitat Politècnica de Catalunya‐BarcelonaTechBarcelonaSpain
| | - Carme Junqué
- Unitat de Psicologia Mèdica, Departament de MedicinaUniversitat de Barcelona (UB)BarcelonaSpain
- Institut de NeurociènciesUniversitat de Barcelona (UB)BarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Maite Garolera
- Grup de Recerca en Cervell, Cognició i ConductaConsorci Sanitari de Terrassa (CST)TerrassaSpain
- Neuropsychology UnitConsorci Sanitari de Terrassa (CST)TerrassaSpain
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Espinoza C, Martella D. Cognitive functions in COVID-19 survivors, approaches strategies, and impact on health systems: a qualitative systematic review. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01662-2. [PMID: 37648954 DOI: 10.1007/s00406-023-01662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Post-COVID syndrome has been defined as signs and symptoms that develop after an infection consistent with COVID-19 and continue for more than 12 weeks, including neurocognitive signs and symptoms that have an impact on the functioning and quality of life of middle-aged adult and older survivors. This systematic review describes the current knowledge of long-term cognitive impairments in COVID-19 survivors, approaches strategies, and their impact on public and private health services worldwide. The systematic review was conducted under the criteria and flowchart established in the PRISMA statement, considering studies from the PubMed, Scopus, and Web of Science databases between 2020 and 2023. The included studies considered participants over 40 years of age, COVID-19 survivors. A total of 68 articles were included, most of which had high to excellent quality. The analysis showed the presence of heterogeneous cognitive symptoms in COVID survivors, persistent for at least 12 weeks from the onset of infection, mostly unsystematized and nonspecific approaches strategies, and a lack of methods for monitoring their effectiveness, with a significant economic and logistical impact on health systems. Specific protocols are required for the rehabilitation of persistent cognitive dysfunction in COVID-19 survivors, as well as longitudinal studies to evaluate the effectiveness of these interventions.
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Affiliation(s)
- Claudia Espinoza
- Escuela de Psicología, Facultad de Ciencias Sociales Y Comunicación, Universidad Santo Tomas, Valdivia, Chile.
| | - Diana Martella
- Departamento de Psicología, Facultad de Ciencias Sociales Y Humanas, Universidad Loyola de Andalucía España, Dos Hermanas, Spain
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Willems S, Didone V, Cabello Fernandez C, Delrue G, Slama H, Fery P, Goin J, Della Libera C, Collette F. COVCOG: Immediate and long-term cognitive improvement after cognitive versus emotion management psychoeducation programs - a randomized trial in covid patients with neuropsychological difficulties. BMC Neurol 2023; 23:307. [PMID: 37596541 PMCID: PMC10436391 DOI: 10.1186/s12883-023-03346-9] [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: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cognitive difficulties are a frequent complaint in long COVID and persist for more than a year post- infection. There is a lack of evidence-based data on effective intervention strategies. Non-pharmacological intervention programs that are used with other neurological populations have not yet been the subject of controlled trials. COVCOG is a multicentric, randomized trial comparing cognitive intervention and a cognitive-behavioural counselling. METHODS/DESIGN Patients with long covid are selected and recruited at least three months post-infection. Patients are randomised in a 1:1 ratio into the cognitive (neuropsychological psychoeducation) and affective (emotion management with cognitive-behavioural counselling) intervention arms. The inclusion of 130 patients is planned. The cognitive intervention includes psycho-educational modules on fatigue and sleep, attention and working memory, executive functions and long-term memory. The affective intervention includes modules on emotion recognition and communication, uncertainty management and behavioral activation. The main objective is to reduce cognitive complaints 2 months after the intervention. A Follow-up is also planned at 8 months. DISCUSSION Given the long-term effects of Covid on cognition and the negative effects of cognitive impairment on quality of life and social participation, it is important to determine whether low-dose, non-pharmacological interventions can be effective. The trial will determine which of the usual types of intervention is the most effective. TRIAL REGISTRATION Clinicaltrials.gov Number: NCT05167266 (21/12/ 2021).
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Affiliation(s)
- Sylvie Willems
- Psychology and Neuroscience of Cognition Unit, Université de Liège, Place Des Orateurs, 1, B33 4000, Liège, Belgium.
- University Psychology and Speech Therapy Clinic, CPLU, Université de Liège, Liège, Belgium.
| | - Vincent Didone
- Psychology and Neuroscience of Cognition Unit, Université de Liège, Place Des Orateurs, 1, B33 4000, Liège, Belgium
| | - Carmen Cabello Fernandez
- Psychology and Neuroscience of Cognition Unit, Université de Liège, Place Des Orateurs, 1, B33 4000, Liège, Belgium
| | - Gael Delrue
- Clinical Neuropsychological Unit, Liège University Hospital, CHU de Liège, Liège, Belgium
| | - Hichem Slama
- Clinical Neuropsychological Unit, Brussel University Hospital, Erasme, Brussels, Belgium
| | - Patrick Fery
- Clinical Neuropsychological Unit, Brussel University Hospital, Erasme, Brussels, Belgium
| | - Julien Goin
- University Psychology and Speech Therapy Clinic, CPLU, Université de Liège, Liège, Belgium
| | - Clara Della Libera
- University Psychology and Speech Therapy Clinic, CPLU, Université de Liège, Liège, Belgium
| | - Fabienne Collette
- Psychology and Neuroscience of Cognition Unit, Université de Liège, Place Des Orateurs, 1, B33 4000, Liège, Belgium
- GIGA-CRC, Université de Liège and Belgian National Fund for Scientific Research, In Vivo Imaging, Liège, Belgium
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6
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Hagen BI, Lerdal A, Søraas A, Landrø NI, Bø R, Småstuen MC, Becker J, Stubberud J. Cognitive rehabilitation in post-COVID-19 condition: A study protocol for a randomized controlled trial. Contemp Clin Trials 2022; 122:106955. [PMID: 36208718 PMCID: PMC9533592 DOI: 10.1016/j.cct.2022.106955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Post-COVID-19 condition is frequently comprised of persistent cognitive sequela, including deficits in attention and executive functions (EFs), which can act as a barrier for regaining pre-illness functional levels. Goal Management Training (GMT) is a cognitive rehabilitation (CR) intervention for improving attention and EFs that has received empirical support in studies of other patient groups. The present study aims to determine the efficacy of GMT for improving everyday attention and EFs in adults who experience persistent cognitive deficits after COVID-19. METHODS This study protocol describes an open-label randomized controlled trial comparing the efficacy of GMT to a wait list control condition (WL), for improving persistent (> 2 months) cognitive sequela in post-COVID-19 condition. The study aims to recruit 240 participants aged 18 to 65 years with a history of SARS-CoV-2 infection and perceived attentional and EF difficulties in daily life. Participants will be block randomized (computer-algorithm) to either group-based GMT (n = 120) or WL (n = 120). GMT will be internet-delivered to groups of six participants in six two-hour sessions delivered once a week. The primary outcome will be the Metacognition Index of the Behavior Rating Inventory of Executive Function - Adult Version, a self-report measure assessing everyday EF difficulties, specifically metacognition, at six months post-treatment. Secondary outcomes include performance-based neurocognitive measures, and tertiary outcomes include rating scales of cognition, emotional health, quality of life, and fatigue. CONCLUSION Study findings could contribute to providing an evidence-based treatment option for symptoms that are frequent and debilitating following a prevalent condition. TRIAL REGISTRATION NUMBER NCT05494424.
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Affiliation(s)
- Bjørn Ingulfsvann Hagen
- Department of Social Education, UiT – The Arctic University of Norway, Harstad, Norway,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway,Corresponding author at: Havnegata 5, 9404 Harstad, Norway
| | - Anners Lerdal
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arne Søraas
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | | | - Ragnhild Bø
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Jacqueline Becker
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
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