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Knapp SAB, Austin DS, Aita SL, Caron JE, Owen T, Borgogna NC, Del Bene VA, Roth RM, Milberg WP, Hill BD. Neurocognitive and psychiatric outcomes associated with postacute COVID-19 infection without severe medical complication: a meta-analysis. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333950. [PMID: 38914455 DOI: 10.1136/jnnp-2024-333950] [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] [Received: 04/03/2024] [Accepted: 06/02/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Cognitive symptoms are often reported by those with a history of COVID-19 infection. No comprehensive meta-analysis of neurocognitive outcomes related to COVID-19 exists despite the influx of studies after the COVID-19 pandemic. This study meta-analysed observational research comparing cross-sectional neurocognitive outcomes in adults with COVID-19 (without severe medical/psychiatric comorbidity) to healthy controls (HCs) or norm-referenced data. METHODS Data were extracted from 54 studies published between January 2020 and June 2023. Hedges' g was used to index effect sizes, which were pooled using random-effects modelling. Moderating variables were investigated using meta-regression and subgroup analyses. RESULTS Omnibus meta-analysis of 696 effect sizes extracted across 54 studies (COVID-19 n=6676, HC/norm-reference n=12 986; average time since infection=~6 months) yielded a small but significant effect indicating patients with COVID-19 performed slightly worse than HCs on cognitive measures (g=-0.36; 95% CI=-0.45 to -0.28), with high heterogeneity (Q=242.30, p<0.001, τ=0.26). Significant within-domain effects was yielded by cognitive screener (g=-0.55; 95% CI=-0.75 to -0.36), processing speed (g=-0.44; 95% CI=-0.57 to -0.32), global cognition (g=-0.40; 95% CI=-0.71 to -0.09), simple/complex attention (g=-0.38; 95% CI=-0.46 to -0.29), learning/memory (g=-0.34; 95% CI=-0.46 to -0.22), language (g=-0.34; 95% CI=-0.45 to -0.24) and executive function (g=-0.32; 95% CI=-0.43 to -0.21); but not motor (g=-0.40; 95% CI=-0.89 to 0.10), visuospatial/construction (g=-0.09; 95% CI=-0.23 to 0.05) and orientation (g=-0.02; 95% CI=-0.17 to 0.14). COVID-19 samples with elevated depression, anxiety, fatigue and disease severity yielded larger effects. CONCLUSION Mild cognitive deficits are associated with COVID-19 infection, especially as detected by cognitive screeners and processing speed tasks. We failed to observe clinically meaningful cognitive impairments (as measured by standard neuropsychological instruments) in people with COVID-19 without severe medical or psychiatric comorbidities.
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Affiliation(s)
- Sarah A B Knapp
- Department of Mental Health, VA Maine Healthcare System, Augusta, Maine, USA
- Department of Mental Health, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - David S Austin
- Department of Mental Health, VA Maine Healthcare System, Augusta, Maine, USA
| | - Stephen L Aita
- Department of Mental Health, VA Maine Healthcare System, Augusta, Maine, USA
- Department of Psychology, University of Maine System, Orono, Maine, USA
| | - Joshua E Caron
- Department of Mental Health, VA Maine Healthcare System, Augusta, Maine, USA
- Department of Psychology, University of Maine System, Orono, Maine, USA
| | - Tyler Owen
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Nicholas C Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Psychology, University of Alabama at Birmingham School of Social and Behavioral Sciences, Birmingham, Alabama, USA
| | - Victor A Del Bene
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Robert M Roth
- Department of Psychiatry, Dartmouth Health, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - William P Milberg
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), Boston VA Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Benjamin D Hill
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
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Birberg Thornberg U, Andersson A, Lindh M, Hellgren L, Divanoglou A, Levi R. Neurocognitive deficits in COVID-19 patients five months after discharge from hospital. Neuropsychol Rehabil 2023; 33:1599-1623. [PMID: 36239662 DOI: 10.1080/09602011.2022.2125020] [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: 02/22/2022] [Accepted: 09/11/2022] [Indexed: 10/17/2022]
Abstract
This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region Östergötland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.
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Affiliation(s)
- Ulrika Birberg Thornberg
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Agnes Andersson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Lindh
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lovisa Hellgren
- Department of Rehabilitation Medicine, Region Jönköping County, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Richard Levi
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Varela-Aldás JL, Buele J, Pérez D, Palacios-Navarro G. Memory rehabilitation during the COVID-19 pandemic. BMC Med Inform Decis Mak 2023; 23:195. [PMID: 37759259 PMCID: PMC10523730 DOI: 10.1186/s12911-023-02294-1] [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: 11/07/2022] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Loss of cognitive and executive functions is a problem that affects people of all ages. That is why it is important to perform exercises for memory training and prevent early cognitive deterioration. The aim of this work was to compare the cognitive performance of the participants after an intervention by using two mnemonic techniques to exercise memory functions (paired-associate learning and method of loci). METHODS A longitudinal study was conducted with 21 healthy participants aged 18 to 55 years over a 2-month period. To assess the impact of this proposal, the NEUROPSI brief battery cognitive assessment test was applied before and after the intervention. In each session, a previous cognitive training was carried out using the paired-associate learning technique, to later perform a task based on the loci method, all from a smart device-based application. The accuracy response and reaction times were automatically collected in the app. RESULTS After the intervention, a statistically significant improvement was obtained in the neuropsychological assessment (NEUROPSI neuropsychological battery) reflected by the Wilcoxon paired signed-rank test (P < .05). CONCLUSION The task based on the method of loci also reflected the well-known age-related effects common to memory assessment tasks. Episodic memory training using the method of loci can be successfully implemented using a smart device app. A stage-based methodological design allows to acquire mnemic skills gradually, obtaining a significant cognitive improvement in a short period of time.
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Affiliation(s)
- José Luis Varela-Aldás
- Centro de Investigaciones de Ciencias Humanas y de la Educación (CICHE), Universidad Indoamérica, Ambato, Ecuador
| | - Jorge Buele
- Centro de Investigaciones de Ciencias Humanas y de la Educación (CICHE), Universidad Indoamérica, Ambato, Ecuador
- Department of Electronic Engineering and Communications, University of Zaragoza, Teruel, Spain
| | - Doris Pérez
- Carrera de Psicología, Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Indoamérica, Ambato, Ecuador
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Ruggeri M, Ricci M, Pagliaro M, Gerace C. Anosmia predicts memory impairment in post-COVID-19 syndrome: results of a neuropsychological cohort study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01670-2. [PMID: 37644214 DOI: 10.1007/s00406-023-01670-2] [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: 03/05/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Recovered COVID-19 patients frequently suffer of cognitive disorders. Several etiopathogenetic mechanisms have been considered for the brain complications in COVID-19 but results are uncertain. Amongst them, an olfactory route to SARS-CoV-2 brain infection might explain cognitive and memory disturbances in post-COVID-19 patients, given the cooccurrence of anosmia and possible underlying limbic involvement. The aims of the study are to investigate cognition of patients with post-COVID-19 syndrome, and to find clinical factors predicting cognitive and memory impairments. 18 patients with post-COVID-19 syndrome underwent neuropsychological assessment and evaluation of clinical parameters. Stepwise regression analysis was used between clinical parameters as factors and cognitive global scores as dependent variables. Since only anosmia predicted memory performances, repeated measures ANOVA of memory scores was conducted between anosmic and non-anosmic patients. We found lack of association between clinical parameters and cognitive performances. Only anosmia was a good predictor for memory performances, with anosmic subjects showing a temporo-mesial amnesic profile. Our study shows novel findings of causal association between transient anosmia during COVID-19 and memory disorders with temporo-mesial dysfunction, probably sharing a common pathophysiological mechanism, and suggesting a possible SARS-CoV 2 infection of the limbic brain via the olfactory route. In contrast to previous studies, cognitive dysfunctions were not associated with respiratory distress, comorbidity, and depression.
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Affiliation(s)
- Massimiliano Ruggeri
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy.
- Rehabilitation Center C.A.R., Rome, Italy.
| | - Monica Ricci
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy
| | | | - Carmela Gerace
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy
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de Groot BO, Biserni C, Fuermaier ABM, Enriquez-Geppert S. Untreated if unrecognized: A cognitive profile of sustained subjective executive dysfunctions in COVID-19. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 37334922 DOI: 10.1080/23279095.2023.2223329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
& STATEMENT OF IMPACTSARS-COV-2 infection can result in acute and long-lasting cognitive complaints, causing ongoing impairments in daily life which poses a challenge to society. Consequently, the evaluation and characterization of cognitive complaints, specifically in the domain of executive functions (EFs) affecting daily life, is imperative in formulating an effective neuropsychological response.In total 442 participants aged 18-65+ years from the Netherlands, Germany, Mexico, and Spain were included in an online questionnaire. Among others, the questionnaire consisted of demographics, the Behavior Rating Inventory of Executive Functioning for Adults (BRIEF-A), measures of subjective disease progression severity and experienced subjective impairment in daily activities. To assess whether daily life activities are affected by EF impairments, the main BRIEF-A composite score (GEC) was analyzed. To determine whether disease-related COVID-19 factors predict EFs complaints in daily life, a stepwise regression analysis was performed with i) experienced disease severity, ii) time since disease, and iii) health risk factor as predictors.The study revealed noteworthy differences in the occurrence of EFs problems in daily life between both groups, as indicated by the GEC, which exhibited a medium effect size even 6 months post-COVID-19 diagnosis even in mild disease progression. The scores of the BRIEF-A subscales follow a domain-specific profile, and includes clinically relevant impairments in: Working memory, Plan/Organize, Task Monitor, Shift, which are affected by the experienced severity of the disease. This cognitive profile has important implications for targeted cognitive training in rehabilitation and has the potential for an applicability to other viruses as well.
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Affiliation(s)
- Bob O de Groot
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Chiara Biserni
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
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Tarantino S, Graziano S, Carducci C, Giampaolo R, Grimaldi Capitello T. Cognitive Difficulties, Psychological Symptoms, and Long Lasting Somatic Complaints in Adolescents with Previous SARS-CoV-2 Infection: A Telehealth Cross-Sectional Pilot Study. Brain Sci 2022; 12:brainsci12080969. [PMID: 35892410 PMCID: PMC9332506 DOI: 10.3390/brainsci12080969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
Background. Few studies have evaluated cognitive functioning and mental health in children and adolescents who contracted the SARS-CoV-2 infection. We investigated the prevalence and association of neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints in a sample of adolescents. Methods. Thirty-one adolescents infected by COVID-19 within 3–6 months prior to the assessment were included. Neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints were evaluated using a checklist and a battery of multiple standardized measures, using a telehealth procedure. Symptoms during the infection were also detected. Results. We included 31 adolescents (23 girls, 8 boys; mean age 14.1, SD = 2). We found borderline scores in 32.3% and 45.2% of our sample for phonemic and category fluency, respectively. A high percentage of participants showed symptoms of depression (80.6%) and anxiety (61.3%). Fifty-eight percent reported at least one long-COVID symptom. The most common symptoms were headache and attention problems (58%). Subjects presenting numbness/weakness, fatigue, brain fog, or attention problems had higher scores in depression, anxiety, and post-traumatic stress symptoms (p ≤ 0.05). Conclusion. This is a pilot study limited by the lack of control group. However, we found that cognitive, psychological, and physical symptoms were very common among adolescents recovered from COVID-19.
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Affiliation(s)
- Samuela Tarantino
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
- Correspondence: ; Tel.: +39-0668592228
| | - Sonia Graziano
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
| | - Chiara Carducci
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
| | - Rosaria Giampaolo
- Department of Paediatric Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Teresa Grimaldi Capitello
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.); (C.C.); (T.G.C.)
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Cian V, De Laurenzis A, Siri C, Gusmeroli A, Canesi M. Cognitive and Neuropsychiatric Features of COVID-19 Patients After Hospital Dismission: An Italian Sample. Front Psychol 2022; 13:908363. [PMID: 35686079 PMCID: PMC9173000 DOI: 10.3389/fpsyg.2022.908363] [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: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Recent studies suggest cognitive, emotional, and behavioral impairments occur in patients after SARS-CoV-2 infection. However, studies are limited to case reports or case series and, to our knowledge, few of them have control groups. This study aims to assess the prevalence of neuropsychological and neuropsychiatric impairment in patients after hospitalization. Methods We enrolled 29 COVID+ patients (M/F: 17/12; age 58.41 ± 10.00 years; education 11.07 ± 3.77 years, 2 left handers) who needed hospitalization but no IC, about 20 days post-dismission, and 29 COVID- healthy matched controls. Neuropsychological and neuropsychiatric assessments were conducted via teleneuropsychology using the following tests: MMSE, CPM47, RAVLT, CDT, Digit-Span Forward/Backward, Verbal fluencies; BDI-II, STAI. People with previous reported cognitive impairment and neurological or psychiatric conditions were excluded. Clinical and demographics were collected. Comparison between groups was conducted using parametric or non-parametric tests according to data distribution (T-test, Mann Withney-U test; Chi-square goodness of fit). Within COVID+ group, we also evaluated the correlation between the cognitive and behavioral assessment scores and clinical variables collected. Results Among COVID+, 62% had at least one pathological test (vs. 13% in COVID-; p = 0.000) and significantly worst performances than COVID- in RAVLT learning (42.55 ± 10.44 vs. 47.9 ± 8.29, p = 0.035), RAVLT recall (8.79 ± 3.13 vs. 10.38 ± 2.19, p = 0.03), and recognition (13.69 ± 1.47 vs. 14.52 ± 0.63, p = 0.07). STAI II was higher in COVID- (32.69 ± 7.66 vs. 39.14 ± 7.7, p = 0.002). Chi-square on dichotomous values (normal/pathological) showed a significant difference between groups in Digit backward test (pathological 7/29 COVID+ vs. 0/29 COVID-; p = 0.005). Conclusions Patients COVID+ assessed by teleneuropsychology showed a vulnerability in some memory and executive functions (working memory, learning, delayed recall, and recognition). Intriguingly, anxiety was higher in the control group. Our findings therefore confirm the impact of COVID-19 on cognition even in patients who did not need IC. Follow-up is needed to evaluate the evolution of COVID-19-related cognitive deficit. Clinical Trial Registration [ClinicalTrials.gov], identifier [NCT05143320].
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Affiliation(s)
- Veronica Cian
- Parkinson’s Disease Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
| | - Alessandro De Laurenzis
- Parkinson’s Disease Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
| | - Chiara Siri
- Parkinson’s Disease Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
| | - Anna Gusmeroli
- Parkinson’s Disease Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
| | - Margherita Canesi
- Parkinson’s Disease Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Italy
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Neuropsychological Outcomes in Adult Patients and Survivors of COVID-19. Pathogens 2022; 11:pathogens11040465. [PMID: 35456140 PMCID: PMC9025655 DOI: 10.3390/pathogens11040465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to affect central nervous system functions through various indirect, and possibly direct, mechanisms. We are only now beginning to understand the possible effects of the virus on human cognition. This review summarizes extant yet limited literature on clinical neuropsychological findings in adult coronavirus disease 2019 (COVID-19) patients and survivors. Neuropsychological outcomes were often in the form of cognitive screen results, although various studies administered comprehensive batteries. With respect to screens, the Montreal Cognitive Assessment appeared relatively sensitive to cognitive dysfunction associated with COVID-19. Patients and survivors presented with weaknesses on screens and comprehensive batteries, although the pattern of these weaknesses was not specific to etiology. Broadly, weaknesses were suggestive of executive dysfunction, although more than one study did not detect significant impairment. Weaknesses should be interpreted cautiously due to potential confounds/contributing factors (weaknesses may partly reflect psychiatric sequelae; weaknesses may be over-interpreted due to inadequate assessment of premorbid functioning). Studies reported different approaches in defining impairment, likely contributing to variable findings. The current review discusses ongoing efforts to harmonize approaches to evaluating neuropsychological functioning globally, as well as emphasizes taking a comprehensive approach towards understanding how the disease affects cognition.
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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: 67] [Impact Index Per Article: 33.5] [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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Hewitt KC, Marra DE, Block C, Cysique LA, Drane DL, Haddad MM, Łojek E, McDonald CR, Reyes A, Eversole K, Bowers D. Central Nervous System Manifestations of COVID-19: A Critical Review and Proposed Research Agenda. J Int Neuropsychol Soc 2022; 28:311-325. [PMID: 33858556 PMCID: PMC10035233 DOI: 10.1017/s1355617721000345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE On March 11, 2020, the World Health Organization declared an outbreak of a new viral entity, coronavirus 2019 (COVID-19), to be a worldwide pandemic. The characteristics of this virus, as well as its short- and long-term implications, are not yet well understood. The objective of the current paper was to provide a critical review of the emerging literature on COVID-19 and its implications for neurological, neuropsychiatric, and cognitive functioning. METHOD A critical review of recently published empirical research, case studies, and reviews pertaining to central nervous system (CNS) complications of COVID-19 was conducted by searching PubMed, PubMed Central, Google Scholar, and bioRxiv. RESULTS After considering the available literature, areas thought to be most pertinent to clinical and research neuropsychologists, including CNS manifestations, neurologic symptoms/syndromes, neuroimaging, and potential long-term implications of COVID-19 infection, were reviewed. CONCLUSION Once thought to be merely a respiratory virus, the scientific and medical communities have realized COVID-19 to have broader effects on renal, vascular, and neurological body systems. The question of cognitive deficits is not yet well studied, but neuropsychologists will undoubtedly play an important role in the years to come.
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Affiliation(s)
- Kelsey C. Hewitt
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
| | - David E. Marra
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL 32610, USA
| | - Cady Block
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
| | - Lucette A. Cysique
- University of New South Wales, Department of Psychology, The Alfred Hospital, Melbourne, 3004, Australia
- St. Vincent’s Applied Medical Research Centre, Sydney, New South Wales, 2011, Australia
| | - Daniel L. Drane
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
- Emory University, Department of Pediatrics, Atlanta, GA 30322, USA
| | - Michelle M. Haddad
- Emory University, Department of Rehabilitation Medicine, Atlanta, GA 30329, USA
| | - Emilia Łojek
- University of Warsaw, Department of Psychology, Warszawa, 00-183, Poland
| | - Carrie R. McDonald
- University of California-San Diego, Department of Psychiatry, La Jolla, CA 92093, USA
| | - Anny Reyes
- University of California-San Diego, Department of Psychiatry, La Jolla, CA 92093, USA
| | - Kara Eversole
- James Madison University, Department of Graduate Psychology, Harrisonburg, VA 22807, USA
| | - Dawn Bowers
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL 32610, USA
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11
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Mauritz M, Trinka E. Akut symptomatische epileptische Anfälle in Assoziation mit COVID-19. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [PMCID: PMC8482359 DOI: 10.1007/s10309-021-00443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Akut symptomatische epileptische Anfälle treten in einem engen zeitlichen Zusammenhang zu einer akuten strukturellen oder funktionellen Schädigung des Gehirns auf, die viele verschiedene Ursachen haben kann. Neurologische Symptome wie Enzephalopathie, Geruchsstörung und Kopfschmerzen finden sich häufig bei COVID-19. Epileptische Anfälle ereignen sich nur in 1–2 % aller mit COVID-19 hospitalisierten Patient*innen. Eine mögliche direkte Invasion des ZNS durch SARS-CoV‑2 sowie indirekte Effekte durch Hypoxie, Inflammation und metabolische Entgleisungen werden als Ursache für die neurologischen Manifestationen bei COVID-19 angenommen.
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Affiliation(s)
- Matthias Mauritz
- Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Ignaz-Harrer-Str. 79, 5020 Salzburg, Österreich
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Salzburg, Österreich
| | - Eugen Trinka
- Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Ignaz-Harrer-Str. 79, 5020 Salzburg, Österreich
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Österreich
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Salzburg, Österreich
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Daroische R, Hemminghyth MS, Eilertsen TH, Breitve MH, Chwiszczuk LJ. Cognitive Impairment After COVID-19-A Review on Objective Test Data. Front Neurol 2021; 12:699582. [PMID: 34393978 PMCID: PMC8357992 DOI: 10.3389/fneur.2021.699582] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: The aim was to conduct a review on the literature on objective cognitive impairment in patients after COVID-19. Methods: We performed a literature review and searched Ovid Medline in February 2021 based on a PECO scheme. Results: Twelve articles met all inclusion criteria. Total patient sample was <1,000. All studies on global cognitive function found impairment, ranging from 15 to 80% of the sampled patients. Seven studies on attention and executive functions reported impairment, with varying results depending on sub-domain and different tests. Three out of four studies reported memory difficulties, with two studies reporting short-term memory deficits. Although results indicate possible language impairment, only one study used domain-specific language tasks. Two out of four studies on visuospatial function did not report any impairment. Conclusion: Patients with recent SARS-CoV-2 infection appear to experience global cognitive impairment, impairment in memory, attention and executive function, and in particular verbal fluency. Based on the current results, we recommend clinicians to evaluate the need for cognitive assessment of patients with a recent COVID-19 infection, regardless of the severity of the disease, treatment methods and length of ICU stay. We need studies with larger sample and control group.
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Affiliation(s)
- Rania Daroische
- Neuropsychological Unit, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
| | - Mathilde S. Hemminghyth
- Neuropsychological Unit, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
| | - Thomas H. Eilertsen
- Neuropsychological Unit, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
| | - Monica H. Breitve
- Neuropsychological Unit, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
- Department of Geriatric Psychiatry, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
| | - Luiza J. Chwiszczuk
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
- Department of Geriatric Psychiatry, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway
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Abstract
PURPOSE OF REVIEW Central and peripheral nervous system manifestations of coronavirus disease 2019 (COVID-19) have been frequently reported and may cause significant morbidity and mortality. This review details the latest evidence on the neuropathogenesis and neurologic complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. RECENT FINDINGS Commonly reported neurologic complications include toxic-metabolic encephalopathy, acute cerebrovascular disorders, seizures, and anoxic-brain injury. These complications represent secondary injury due to COVID-19 related hypoxia, sepsis, hypercoagulability, or hyperinflammation. Postinfectious complications, such as encephalitis, postinfectious demyelination, and Guillain-Barré syndrome have been reported, but are rare. Recent reports of persistent neurocognitive symptoms highlight the possibility of lasting impairment. SUMMARY Although some neurologic complications should be treated with standard practices, further investigations are still needed to determine the optimal treatment of COVID-related neurologic complications, such as ischemic stroke. Entering into the next phase of the pandemic, investigations into the long-term neurologic and cognitive impacts of SARS-CoV-2 infection will be needed. Clinicians must have a high clinical suspicion for both acute and chronic neurologic complications among COVID-19 patients.
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A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications. J Neurol Sci 2021; 426:117486. [PMID: 34000678 PMCID: PMC8113108 DOI: 10.1016/j.jns.2021.117486] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Background Little is known regarding long-term outcomes of patients hospitalized with COVID-19. Methods We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Results Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23–3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29–0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups. Conclusions Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.
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