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Melillo A, Perrottelli A, Caporusso E, Coltorti A, Giordano GM, Giuliani L, Pezzella P, Bucci P, Mucci A, Galderisi S, Maj M. Research evidence on the management of the cognitive impairment component of the post-COVID condition: a qualitative systematic review. Eur Psychiatry 2024; 67:e60. [PMID: 39328154 DOI: 10.1192/j.eurpsy.2024.1770] [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] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Cognitive impairment (CI) is one of the most prevalent and burdensome consequences of COVID-19 infection, which can persist up to months or even years after remission of the infection. Current guidelines on post-COVID CI are based on available knowledge on treatments used for improving CI in other conditions. The current review aims to provide an updated overview of the existing evidence on the efficacy of treatments for post-COVID CI. METHODS A systematic literature search was conducted for studies published up to December 2023 using three databases (PubMed-Scopus-ProQuest). Controlled and noncontrolled trials, cohort studies, case series, and reports testing interventions on subjects with CI following COVID-19 infection were included. RESULTS After screening 7790 articles, 29 studies were included. Multidisciplinary approaches, particularly those combining cognitive remediation interventions, physical exercise, and dietary and sleep support, may improve CI and address the different needs of individuals with post-COVID-19 condition. Cognitive remediation interventions can provide a safe, cost-effective option and may be tailored to deficits in specific cognitive domains. Noninvasive brain stimulation techniques and hyperbaric oxygen therapy showed mixed and preliminary results. Evidence for other interventions, including pharmacological ones, remains sparse. Challenges in interpreting existing evidence include heterogeneity in study designs, assessment tools, and recruitment criteria; lack of long-term follow-up; and under-characterization of samples in relation to confounding factors. CONCLUSIONS Further research, grounded on shared definitions of the post-COVID condition and on the accurate assessment of COVID-related CI, in well-defined study samples and with longer follow-ups, is crucial to address this significant unmet need.
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Affiliation(s)
- Antonio Melillo
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Perrottelli
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Caporusso
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Coltorti
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giulia Maria Giordano
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Pezzella
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Bucci
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvana Galderisi
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- World Health Organization (WHO) Collaborating Center, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gorenshtein A, Liba T, Leibovitch L, Stern S, Stern Y. Intervention modalities for brain fog caused by long-COVID: systematic review of the literature. Neurol Sci 2024; 45:2951-2968. [PMID: 38695969 PMCID: PMC11176231 DOI: 10.1007/s10072-024-07566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 06/15/2024]
Abstract
Individuals suffering from long-COVID can present with "brain fog", which is characterized by a range of cognitive impairments, such as confusion, short-term memory loss, and difficulty concentrating. To date, several potential interventions for brain fog have been considered. Notably, no systematic review has comprehensively discussed the impact of each intervention type on brain fog symptoms. We included studies on adult (aged > 18 years) individuals with proven long- COVID brain-fog symptoms from PubMed, MEDLINE, Central, Scopus, and Embase. A search limit was set for articles published between 01/2020 and 31/12/2023. We excluded studies lacking an objective assessment of brain fog symptoms and patients with preexisting neurological diseases that affected cognition before COVID-19 infection. This review provided relevant information from 17 studies. The rehabilitation studies utilized diverse approaches, leading to a range of outcomes in terms of the effectiveness of the interventions. Six studies described noninvasive brain stimulation, and all showed improvement in cognitive ability. Three studies described hyperbaric oxygen therapy, all of which showed improvements in cognitive assessment tests and brain perfusion. Two studies showed that the use of Palmitoylethanolamide and Luteolin (PEA-LUT) improved cognitive impairment. Noninvasive brain stimulation and hyperbaric oxygen therapy showed promising results in the treatment of brain fog symptoms caused by long-COVID, with improved perfusion and cortical excitability. Furthermore, both rehabilitation strategies and PEA-LUT administration have been associated with improvements in symptoms of brain fog. Future studies should explore combinations of interventions and include longer follow-up periods to assess the long-term effects of these treatments.
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Affiliation(s)
- Alon Gorenshtein
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Tom Liba
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Shai Stern
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yael Stern
- Maccabi Healthcare Services, Tel Aviv-Yafo, Israel
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Alashram AR. Effectiveness of aerobic exercise on cognition in individuals with traumatic brain injury: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 38470898 DOI: 10.1080/23279095.2024.2327829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Cognitive deficits are among the most common impairments in individuals with traumatic brain injury (TBI). Aerobic exercise is a repetitive and structured physical activity that influences structural and functional brain alterations differently. This review aims to examine the effects of aerobic exercise on cognition in individuals with TBI. PubMed, CINAHL, EMBASE, SCOPUS, MEDLINE, and Web of Science were searched from inception to December 20, 2023. Studies designed as randomized controlled trials (RCT), clinical controlled trials (CCT), and pilot studies included individuals with a confirmed diagnosis of TBI, comparing aerobic exercise with passive, active, or no control group and included at least one outcome measure assessing any cognitive domain were selected. The quality of the selected studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Six studies met the eligibility criteria (n = 118), with 53% of participants being female. Four studies were of good quality, fair quality (n = 1), and poor quality (n = 1) on the PEDro. Two of the selected studies showed significant improvements in cognition after moderate and vigorous aerobic exercises, while four studies indicated that moderate and vigorous aerobic exercise did not improve cognition post-TBI. The evidence on the effects of moderate and vigorous aerobic exercise on cognitive function post-TBI remains limited. Additional studies are strongly warranted to understand aerobic exercise's effects on cognition post-TBI.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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Alashram AR. Compensatory cognitive training for people with traumatic brain injury: A systematic review of randomized controlled trial. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 38285433 DOI: 10.1080/23279095.2024.2306133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Cognitive impairments are a common consequence in people with traumatic brain injury (TBI). Compensatory cognitive training is a therapeutic strategy that offers alternative methods to manage cognitive deficits. This systematic review aims to examine the effects of compensatory cognitive training on cognitive function in people with TBI. We searched PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, and EMBASE from inception until October 2023. The Cochrane Collaboration tool was used to assess the methodological quality of the selected studies. Of 318 articles, eight studies (n = 615), with 8% of participants being females, were included in this review. Four studies were classified as having 'high' quality according to the Cochrane Collaboration tool, while four were categorized as 'moderate' quality. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The effects of compensatory cognitive training on cognitive outcomes showed inconsistency. In conclusion, the evidence for the effects of compensatory cognitive training on cognition in people with TBI is promising. Further trials are needed to investigate the effects of compensatory cognitive training on various cognitive domains in people with TBI.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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Wang YM, Zhu N, Zhou YM, Su R, Li HL, Zhou JX. The combination of arterial lactate level with GCS-pupils score to evaluate short term prognosis in traumatic brain injury: a retrospective study. BMC Neurol 2022; 22:430. [PMCID: PMC9664667 DOI: 10.1186/s12883-022-02970-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The aim of the study was to determine whether the combination of Glasgow Coma Scale (GCS) and Pupil responses score (GCSP) with arterial lactate level would be an index to predict the short term prognosis in patients with traumatic brain injury (TBI).
Methods
A retrospective study was performed enrolling all TBI patients admitted to intensive care unit (ICU) from 2019 to 2020. The demographics, clinical characteristics, and arterial lactate concentration were recorded. The GCSP and arterial blood analysis (ABG) with lactate was tested as soon as the patient was admitted to ICU. The Glasgow Outcome Scale (GOS) after discharge was regarded as the clinical outcome. A new index named GCSP-L was the combination of GCSP and lactate concentration. GCSP-L was the GCSP score (range 1-15) plus the lactate score (range 0-2). The lactate score was defined based on different lactate concentrations. If lactate was below 2 mmol/L, lactate score was 0, which above 5 mmol/L was 2 and between 2 and 5 mmol/L, the score was 1. As the range of GCSP was 1-15, the range of the GCSP-L was 1 to 17. The area under receiver operating characteristic curve (AUC) was calculated to evaluate the predictive ability of GCSP, lactate and GCSP-L. Statistical significance was set when p value < 0.05.
Results
A total of 192 TBI patients were included in the study. Based on GCSP, mild, moderate, and severe TBI were 13.02, 14.06 and 72.92%, respectively. There were 103 (53.65%) patients with the lactate concentration below 2 mmol/L (1.23 ± 0.37 mmol/l), 63 (32.81%) of the range from 2 to 5 (3.04 ± 2.43 mmol/l) and 26 (13.54%) were above 5 mmol/l (7.70 ± 2.43 mmol/l). The AUC was 0.866 (95% CI 0.827-0.904) for GCSP-L, 0.812 (95% CI 0.765-0.858) for GCSP and 0.629 (95% CI 0.570—0.0.688) for lactate. The AUC of GCSP-L was higher than the other two, GCSP and lactate alone.
Conclusions
The combination of GCSP and lactate concentration can be used to predict the short term prognosis in TBI patients.
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Chen Y, Wang L, You W, Huang F, Jiang Y, Sun L, Wang S, Liu S. Hyperbaric oxygen therapy promotes consciousness, cognitive function, and prognosis recovery in patients following traumatic brain injury through various pathways. Front Neurol 2022; 13:929386. [PMID: 36034283 PMCID: PMC9402226 DOI: 10.3389/fneur.2022.929386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study was to investigate the clinical curative effect of hyperbaric oxygen (HBO) treatment and its mechanism in improving dysfunction following traumatic brain injury (TBI). Methods Patients were enrolled into control and HBO groups. Glasgow coma scale (GCS) and coma recovery scale-revised (CRS-R) scores were used to measure consciousness; the Rancho Los Amigos scale-revised (RLAS-R) score was used to assess cognitive impairment; the Stockholm computed tomography (CT) score, quantitative electroencephalography (QEEG), and biomarkers, including neuron-specific enolase (NSE), S100 calcium-binding protein beta (S100β), glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and vascular endothelial growth factor (VEGF), were used to assess TBI severity. The patients were followed up 6 months after discharge and assessed with the Glasgow outcome scale-extended (GOSE), functional independence measure (FIM), and the disability rating scale (DRS). Results The CRS-R scores were higher in the HBO group than the control group at 10 days after treatment. The RLAS-R scores were higher in the HBO group than the control group at 10 and 20 days after treatment. The Stockholm CT scores were significantly lower in the HBO group than the control group at 10 days after treatment. HBO depressed the (δ + θ)/(α + β) ratio (DTABR) of EEG, with lower δ band relative power and higher α band relative power than those in the control group. At 20 days after treatment, the expression of NSE, S100β, and GFAP in the HBO group was lower than that in controls, whereas the expression of BDNF, NGF, and VEGF in the HBO group was higher than that in controls. Six months after discharge, the HBO group had lower DRS scores and higher FIM and GOSE scores than the control group significantly. Conclusions HBO may be an effective treatment for patients with TBI to improve consciousness, cognitive function and prognosis through decreasing TBI-induced hematoma volumes, promoting the recovery of EEG rhythm, and modulating the expression of serum NSE, S100β, GFAP, BDNF, NGF, and VEGF.
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Affiliation(s)
- Yuwen Chen
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- School of Medicine, Nantong University, Nantong, China
| | - Liang Wang
- School of Medicine, Nantong University, Nantong, China
- Department of Rehabilitation, Nantong First People's Hospital, Nantong, China
| | - Wenjun You
- Department of Geriatrics, Second Peoples Hospital of Nantong, Affiliated of Nantong University, Nantong, China
| | - Fei Huang
- School of Medicine, Nantong University, Nantong, China
- Department of Rehabilitation Medicine, Nantong Health College of Jiangsu Province, Nantong, China
| | - Yingzi Jiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- School of Medicine, Nantong University, Nantong, China
| | - Li Sun
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Siye Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Su Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- *Correspondence: Su Liu
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