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Llana T, Garces-Arilla S, Juan MC, Mendez-Lopez M, Mendez M. An immersive virtual reality-based object-location memory task reveals spatial long-term memory alterations in Long-COVID. Behav Brain Res 2024; 471:115127. [PMID: 38936427 DOI: 10.1016/j.bbr.2024.115127] [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: 10/19/2023] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
Object-location memory (OLM) is a type of declarative memory for spatial information and consists of the individual's ability to establish accurate associations between objects and their spatial locations. Long-COVID describes the long-term effects of the COVID-19 disease. Long-COVID patients show medial temporal lobe dysfunction and neuropsychological alterations affecting memory. This study aimed to assess OLM in a group of Long-COVID patients, n=66, and a Control group of healthy individuals with similar age and sex composition, n=21, using an immersive virtual reality (iVR)-based OLM task. We also explored associations between the performance in the iVR-based OLM task and general cognitive function (MoCA), and both verbal (VSTM) and visuospatial (SSTM) span. The Long-COVID group showed fewer correct responses, made more task attempts, and invested more time in the iVR-based OLM task than the Control group. Delayed memory was more severely altered than immediate memory in Long-COVID participants. Better MoCA scores of the Long-COVID group were strongly associated with shorter times to complete the immediate recall of the iVR-based OLM task. Besides, the months elapsed since the COVID-19 infection were slightly associated with fewer correct responses in the immediate and 24-hour recalls. These results corroborate previous findings of memory alterations in the Long-COVID syndrome using an iVR-based OLM task, adding new evidence on spatial memory and long-term memory in this population. Implementing spatial iVR tasks to clinical research may improve our understanding of neuropsychological disorders.
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Affiliation(s)
- Tania Llana
- Neuroscience Institute of Principado de Asturias (INEUROPA), Faculty of Psychology, Plaza Feijoo s/n, Oviedo, Asturias 33003, Spain; Department of Psychology, University of Oviedo, Faculty of Psychology, Plaza Feijoo s/n, Oviedo, Asturias 33003, Spain.
| | - Sara Garces-Arilla
- Department of Psychology and Sociology, University of Zaragoza, Pedro Cerbuna 12, Zaragoza, Aragón 50009, Spain.
| | - M-Carmen Juan
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camino de Vera, s/n, Valencia 46022, Spain.
| | - Magdalena Mendez-Lopez
- Department of Psychology and Sociology, University of Zaragoza, Pedro Cerbuna 12, Zaragoza, Aragón 50009, Spain; IIS Aragón, San Juan Bosco, 13, Zaragoza, Aragón 50009, Spain.
| | - Marta Mendez
- Neuroscience Institute of Principado de Asturias (INEUROPA), Faculty of Psychology, Plaza Feijoo s/n, Oviedo, Asturias 33003, Spain; Department of Psychology, University of Oviedo, Faculty of Psychology, Plaza Feijoo s/n, Oviedo, Asturias 33003, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario, s/n, Oviedo, Asturias 33011, Spain.
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Liu Y, Huang C, Xiong Y, Wang X, Shen Z, Zhang M, Gao N, Wang N, Du G, Zhan H. The causal relationship between human brain morphometry and knee osteoarthritis: a two-sample Mendelian randomization study. Front Genet 2024; 15:1420134. [PMID: 39040992 PMCID: PMC11260717 DOI: 10.3389/fgene.2024.1420134] [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: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background Knee Osteoarthritis (KOA) is a prevalent and debilitating condition affecting millions worldwide, yet its underlying etiology remains poorly understood. Recent advances in neuroimaging and genetic methodologies offer new avenues to explore the potential neuropsychological contributions to KOA. This study aims to investigate the causal relationships between brain-wide morphometric variations and KOA using a genetic epidemiology approach. Method Leveraging data from 36,778 UK Biobank participants for human brain morphometry and 487,411 UK Biobank participants for KOA, this research employed a two-sample Mendelian Randomization (TSMR) approach to explore the causal effects of 83 brain-wide volumes on KOA. The primary method of analysis was the Inverse Variance Weighted (IVW) and Wald Ratio (WR) method, complemented by MR Egger and IVW methods for heterogeneity and pleiotropy assessments. A significance threshold of p < 0.05 was set to determine causality. The analysis results were assessed for heterogeneity using the MR Egger and IVW methods. Brain-wide volumes with Q_pval < 0.05 were considered indicative of heterogeneity. The MR Egger method was employed to evaluate the pleiotropy of the analysis results, with brain-wide volumes having a p-value < 0.05 considered suggestive of pleiotropy. Results Our findings revealed significant causal associations between KOA and eight brain-wide volumes: Left parahippocampal volume, Right posterior cingulate volume, Left transverse temporal volume, Left caudal anterior cingulate volume, Right paracentral volume, Left paracentral volume, Right lateral orbitofrontal volume, and Left superior temporal volume. These associations remained robust after tests for heterogeneity and pleiotropy, underscoring their potential role in the pathogenesis of KOA. Conclusion This study provides novel evidence of the causal relationships between specific brain morphometries and KOA, suggesting that neuroanatomical variations might contribute to the risk and development of KOA. These findings pave the way for further research into the neurobiological mechanisms underlying KOA and may eventually lead to the development of new intervention strategies targeting these neuropsychological pathways.
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Affiliation(s)
- Yongming Liu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chao Huang
- Yunyang County People’s Hospital Rehabilitation Medicine Department, Chongqing, China
| | - Yizhe Xiong
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhibi Shen
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Mingcai Zhang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ningyang Gao
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Nan Wang
- Department of Traditional Chinese Medicine, Shanghai Yangzhi Rehabilitation Hospital (Yangzhi Affiliated Rehabilitation Hospital), School of Medicine, Tongji University, Shanghai, China
| | - Guoqing Du
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Carmona-Cervelló M, León-Gómez BB, Dacosta-Aguayo R, Lamonja-Vicente N, Montero-Alía P, Molist G, Ayet A, Chacón C, Costa-Garrido A, López-Lifante VM, Zamora-Putin V, Liutsko L, García-Sierra R, Fornés A, Moreno-Gabriel E, Massanella M, Muñoz-Moreno JA, Rodríguez-Pérez MC, Mateu L, Prats A, Mataró M, Boigues M, Quirant B, Prado JG, Martínez-Cáceres E, Violán C, Torán-Monserrat P. Long COVID: cognitive, balance, and retina manifestations. Front Med (Lausanne) 2024; 11:1399145. [PMID: 39036098 PMCID: PMC11260168 DOI: 10.3389/fmed.2024.1399145] [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: 03/11/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Background The neurological symptoms of Long COVID (LC) and the impact of neuropsychological manifestations on people's daily lives have been extensively described. Although a large body of literature describes symptoms, validating this with objective measures is important. This study aims to identify and describe the effects of Long COVID on cognition, balance, and the retinal fundus, and determine whether the duration of symptoms influences cognitive impairment. Methods This cross-sectional study involved LC volunteers with cognitive complaint from public health centers in northern Barcelona who participated between January 2022 and March 2023. This study collected sociodemographic characteristics, information on substance use, comorbidities, and clinical data related to COVID-19. We measured five cognitive domains using a battery of neuropsychological tests. Balance was assessed through posturography and retinal vascular involvement by retinography. Results A total of 166 people with LC and cognitive complaints participated, 80.72% were women and mean age was 49.28 ± 8.39 years. The most common self-reported symptoms were concentration and memory deficit (98.80%), brain fog (82.53%) and insomnia (71.17%). The 68.67% presented cognitive deficit in at least one domain, with executive functions being the most frequent (43.98%). The 51.52% of the participants exhibited a dysfunctional pattern in balance, and 9.2% showed some alteration in the retina. There were no statistically significant differences between cognitive impairment and symptom duration. Conclusion Our findings contribute to a more comprehensive understanding of the pathology associated with Long COVID. They highlight the diversity of self-reported symptoms, the presence of abnormal balance patterns, and some cognitive impairment. These findings underscore the necessity of addressing the clinical management of this condition in primary care through follow-up and the pursuit of multidisciplinary and comprehensive treatment.
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Affiliation(s)
- Meritxell Carmona-Cervelló
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Brenda Biaani León-Gómez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Rosalia Dacosta-Aguayo
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Gemma Molist
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Faculty of Medicine, University of Vic-Central University of Vic, Barcelona, Spain
| | - Aitana Ayet
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Palau-Solità Healthcare Centre, Institut Català de la Salut, Palau-Solità Plegamans, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valeria Zamora-Putin
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Palau-Solità Healthcare Centre, Institut Català de la Salut, Palau-Solità Plegamans, Barcelona, Spain
| | - Liudmila Liutsko
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Rosa García-Sierra
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antònia Fornés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Social Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Massanella
- IrsiCaixa-AIDS Research Institute, Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Red Española de investigación en Covid Persisitente, Barcelona, Spain
| | - Jose A. Muñoz-Moreno
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - M. Carmen Rodríguez-Pérez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Lourdes Mateu
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Red Española de investigación en Covid Persisitente, Barcelona, Spain
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Anna Prats
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Marc Boigues
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Cellular Biology, Physiology and Immunology,Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Bibiana Quirant
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Cellular Biology, Physiology and Immunology,Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Julia G. Prado
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- IrsiCaixa-AIDS Research Institute, Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eva Martínez-Cáceres
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Medicine, Faculty of Medicine,Universitat de Girona, Girona, Spain
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García-Meléndez DD, Presa RM, Castro PQ, Calleja BS, Calvo SR, Morales-Casado MI. Comparative imaging study of patients with persistent olfactory dysfunction due to mild COVID-19 using structural and functional MRI. Med Clin (Barc) 2024:S0025-7753(24)00354-3. [PMID: 38960797 DOI: 10.1016/j.medcli.2024.04.021] [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: 12/07/2023] [Revised: 03/15/2024] [Accepted: 04/12/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Persistent post-COVID olfactory dysfunction continues to be studied due to the controversy in its pathophysiology and neuroimaging. MATERIALS AND METHODS The patients had confirmed mild COVID-19 infection with olfactory dysfunction of more than one month of evolution and they were compared to controls with normal olfaction, assessed using the Sniffin' Sticks Olfactory Test and underwent brain, magnetic resonance imaging (MRI) of the olfactory bulb and olfactory function. RESULTS A total of 8 patients and 2 controls participated. The average age of the patients was 34.5 years (SD 8.5), and that of the controls was 28.5 (SD 2.1). The average score in the patients' olfactory test was 7.9 points (SD 2.2). In brain and olfactory bulb MRI tests, no morphological differences were found. When evaluated by functional MRI, none of the patients activated the entorhinal area in comparison to the controls, who did show activation at this level. Activation of secondary olfactory areas in cases and controls were as follows: orbitofrontal (25% vs 100%), basal ganglia (25% vs 50%) and insula (38% vs 0%) respectively. CONCLUSIONS There were no observed morphological changes in the brain MRI. Unlike the controls, none of the patients activated the entorhinal cortex in the olfactory functional MRI.
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Silva-Passadouro B, Tamasauskas A, Khoja O, Casson AJ, Delis I, Brown C, Sivan M. A systematic review of quantitative EEG findings in Fibromyalgia, Chronic Fatigue Syndrome and Long COVID. Clin Neurophysiol 2024; 163:209-222. [PMID: 38772083 DOI: 10.1016/j.clinph.2024.04.019] [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: 12/04/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024]
Abstract
Fibromyalgia Syndrome (FMS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID (LC) are similar multisymptom clinical syndromes but with difference in dominant symptoms in each individual. There is existing and emerging literature on possible functional alterations of the central nervous system in these conditions. This review aims to synthesise and appraise the literature on resting-state quantitative EEG (qEEG) in FMS, ME/CFS and LC, drawing on previous research on FMS and ME/CFS to help understand neuropathophysiology of the new condition LC. A systematic search of MEDLINE, Embase, CINHAL, PsycINFO and Web of Science databases for articles published between December 1994 and September 2023 was performed. Out of the initial 2510 studies identified, 17 articles were retrieved that met all the predetermined selection criteria, particularly of assessing qEEG changes in one of the three conditions compared to healthy controls. All studies scored moderate to high quality on the Newcastle-Ottawa scale. There was a general trend for decreased low-frequency EEG band activity (delta, theta, and alpha) and increased high-frequency EEG beta activity in FMS, differing to that found in ME/CFS. The limited LC studies included in this review focused mainly on cognitive impairments and showed mixed findings not consistent with patterns observed in FMS and ME/CFS. Our findings suggest different patterns of qEEG brainwave activity in FMS and ME/CFS. Further research is required to explore whether there are phenotypes within LC that have EEG signatures similar to FMS or ME/CFS. This could inform identification of reliable diagnostic markers and possible targets for neuromodulation therapies tailored to each clinical syndrome.
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Affiliation(s)
- Bárbara Silva-Passadouro
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.
| | - Arnas Tamasauskas
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Omar Khoja
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Alexander J Casson
- Department of Electrical and Electronic Engineering, University of Manchester, Manchester, UK
| | - Ioannis Delis
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Christopher Brown
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK; National Demonstration Centre in Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Gao Y, Lin K, Wang B, Ji W, Liu J, Du M, Wang W, Li Y, Du X, Wang Y, Jiang T. Decision-making ability limitations and brain neural activity changes in healthcare workers after mild COVID-19. Neurosci Res 2024; 204:14-21. [PMID: 38355017 DOI: 10.1016/j.neures.2024.02.001] [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: 08/16/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Studies have demonstrated that the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) extensively affects brain function. Although cognitive dysfunction is considered a common manifestation in COVID-19 patients during the recovery period, the potential changes in decision-making ability, are not yet clear. Decision-making functions are essential to the work of healthcare workers. However, there is a lack of a multidimensional assessment of its functioning in COVID-19 cases. Here, we used tests combined with the resting-state functional magnetic resonance imaging (rs-fMRI) stabilization feature amplitude of low-frequency fluctuations (ALFF) to explore decision-making behavior and brain neural activity changes in healthcare workers after mild COVID-19. Participants were divided into the SARS-CoV-2 infected group (SI, n = 41) and healthy controls (HC, n = 42). All participants underwent a series of neuropsychological tests. They performed the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT), followed by fMRI (n = 20) to assess their decision-making ability under ambiguous and risky conditions and changes in brain neural activity. The SI group performed worse in verbal memory than the HC group. Furthermore, the SI group performed worse in the IGT, whereas no significant difference was observed in the GDT. In addition, rs-fMRI showed enhanced spontaneous neural activity in the postcentral gyrus and inferior parietal lobe in the SI group compared to the HC group.
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Affiliation(s)
- Yaotian Gao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Keyi Lin
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Bangyue Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Ji
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China; Department of Neurosurgery, Huaan Brain Hospital, Hefei, China
| | - Jia Liu
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengcheng Du
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Li
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaowen Du
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Tao Jiang
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China; Anhui Provincial Institute of Translational Medicine, Hefei, China.
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Schreiber CS, Wiesweg I, Stanelle-Bertram S, Beck S, Kouassi NM, Schaumburg B, Gabriel G, Richter F, Käufer C. Sex-specific biphasic alpha-synuclein response and alterations of interneurons in a COVID-19 hamster model. EBioMedicine 2024; 105:105191. [PMID: 38865747 PMCID: PMC11293593 DOI: 10.1016/j.ebiom.2024.105191] [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: 12/13/2023] [Revised: 05/02/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) frequently leads to neurological complications after recovery from acute infection, with higher prevalence in women. However, mechanisms by which SARS-CoV-2 disrupts brain function remain unclear and treatment strategies are lacking. We previously demonstrated neuroinflammation in the olfactory bulb of intranasally infected hamsters, followed by alpha-synuclein and tau accumulation in cortex, thus mirroring pathogenesis of neurodegenerative diseases such as Parkinson's or Alzheimer's disease. METHODS To uncover the sex-specific spatiotemporal profiles of neuroinflammation and neuronal dysfunction following intranasal SARS-CoV-2 infection, we quantified microglia cell density, alpha-synuclein immunoreactivity and inhibitory interneurons in cortical regions, limbic system and basal ganglia at acute and late post-recovery time points. FINDINGS Unexpectedly, microglia cell density and alpha-synuclein immunoreactivity decreased at 6 days post-infection, then rebounded to overt accumulation at 21 days post-infection. This biphasic response was most pronounced in amygdala and striatum, regions affected early in Parkinson's disease. Several brain regions showed altered densities of parvalbumin and calretinin interneurons which are involved in cognition and motor control. Of note, females appeared more affected. INTERPRETATION Our results demonstrate that SARS-CoV-2 profoundly disrupts brain homeostasis without neuroinvasion, via neuroinflammatory and protein regulation mechanisms that persist beyond viral clearance. The regional patterns and sex differences are in line with neurological deficits observed after SARS-CoV-2 infection. FUNDING Federal Ministry of Health, Germany (BMG; ZMV I 1-2520COR501 to G.G.), Federal Ministry of Education and Research, Germany (BMBF; 03COV06B to G.G.), Ministry of Science and Culture of Lower Saxony in Germany (14-76403-184, to G.G. and F.R.).
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Affiliation(s)
- Cara Sophie Schreiber
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany
| | - Ivo Wiesweg
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Sebastian Beck
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Nancy Mounogou Kouassi
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Berfin Schaumburg
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Gülsah Gabriel
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany; Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Franziska Richter
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
| | - Christopher Käufer
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
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Cahan J, Finley JCA, Cotton E, Orban ZS, Jimenez M, Weintraub S, Sorets T, Koralnik IJ. Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status. Front Neurol 2024; 15:1401796. [PMID: 38994492 PMCID: PMC11236596 DOI: 10.3389/fneur.2024.1401796] [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: 03/15/2024] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
This study sought to characterize cognitive functioning in patients with neurological post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) and investigate the association of subjective and objective functioning along with other relevant factors with prior hospitalization for COVID-19. Participants were 106 adult outpatients with Neuro-PASC referred for abbreviated neuropsychological assessment after scoring worse than one standard deviation below the mean on cognitive screening. Of these patients, 23 had been hospitalized and 83 had not been hospitalized for COVID-19. Subjective cognitive impairment was evaluated with the self-report cognition subscale from the Patient-Reported Outcome Measurement Information System. Objective cognitive performance was assessed using a composite score derived from multiple standardized cognitive measures. Other relevant factors, including fatigue and depression/mood symptoms, were assessed via the Patient-Reported Outcome Measurement Information System. Subjective cognitive impairment measures exceeded the minimal difficulties noted on objective tests and were associated with depression/mood symptoms as well as fatigue. However, fatigue independently explained the most variance (17.51%) in patients' subjective cognitive ratings. When adjusting for fatigue and time since onset of COVID-19 symptoms, neither objective nor subjective impairment were associated with prior hospitalization for COVID-19. Findings suggest that abbreviated neuropsychological assessment may not reveal objective difficulties beyond initial cognitive screening in patients with Neuro-PASC. However, subjective cognitive concerns may persist irrespective of hospitalization status, and are likely influenced by fatigue and depression/mood symptoms. The impact of concomitant management of fatigue and mood in patients with Neuro-PASC who report cognitive concerns deserve further study.
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Affiliation(s)
- Joshua Cahan
- Northwestern Medicine, Davee Department of Neurology, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Chicago, IL, United States
| | | | - Erica Cotton
- Northwestern Medicine, Davee Department of Neurology, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Northwestern Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Zachary S. Orban
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Millenia Jimenez
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sandra Weintraub
- Northwestern Medicine, Davee Department of Neurology, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Chicago, IL, United States
- Northwestern Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Tali Sorets
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Igor J. Koralnik
- Northwestern Medicine, Davee Department of Neurology, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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9
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Chien C, Heine J, Khalil A, Schlenker L, Hartung TJ, Boesl F, Schwichtenberg K, Rust R, Bellmann-Strobl J, Franke C, Paul F, Finke C. Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome. Ann Clin Transl Neurol 2024. [PMID: 38874398 DOI: 10.1002/acn3.52121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Persisting neurological symptoms after COVID-19 affect up to 10% of patients and can manifest in fatigue and cognitive complaints. Based on recent evidence, we evaluated whether cerebral hemodynamic changes contribute to post-COVID syndrome (PCS). METHODS Using resting-state functional magnetic resonance imaging, we investigated brain perfusion and oxygen level estimates in 47 patients (44.4 ± 11.6 years; F:M = 38:9) and 47 individually matched healthy control participants. Group differences were calculated using two-sample t-tests. Multivariable linear regression was used for associations of each regional perfusion and oxygen level measure with cognition and sleepiness measures. Exploratory hazard ratios were calculated for each brain metric with clinical measures. RESULTS Patients presented with high levels of fatigue (79%) and daytime sleepiness (45%). We found widespread decreased brain oxygen levels, most evident in the white matter (false discovery rate adjusted-p-value (p-FDR) = 0.038) and cortical grey matter (p-FDR = 0.015). Brain perfusion did not differ between patients and healthy participants. However, delayed patient caudate nucleus perfusion was associated with better executive function (p-FDR = 0.008). Delayed perfusion in the cortical grey matter and hippocampus were associated with a reduced risk of daytime sleepiness (hazard ratio (HR) = 0.07, p = 0.037 and HR = 0.06, p = 0.034). Decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22, p = 0.019). Meanwhile, lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29, p = 0.017). INTERPRETATION Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function. These hemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.
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Affiliation(s)
- Claudia Chien
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Josephine Heine
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ahmed Khalil
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars Schlenker
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institut für Med. Immunologie, Immundefektambulanz, Berlin, Germany
| | - Tim J Hartung
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Boesl
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katia Schwichtenberg
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rebekka Rust
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institut für Med. Immunologie, Immundefektambulanz, Berlin, Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiana Franke
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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10
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Rudroff T. Long COVID in Brain Health Research: A Call to Action. Brain Sci 2024; 14:587. [PMID: 38928587 PMCID: PMC11201626 DOI: 10.3390/brainsci14060587] [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: 05/22/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic has brought attention to the long-term consequences of the virus, particularly the persistent symptoms that characterize long COVID. This syndrome, which can last for months after the initial infection, includes a range of neurological and neuropsychiatric manifestations that have significant implications for brain health and dementia research. This review explores the current understanding of long COVID's cognitive, neurological, and psychiatric symptoms and their potential impact on brain stimulation and neuroimaging studies. It argues that researchers must adapt their study designs and screening processes to account for the confounding effects of long COVID and ensure the accuracy and reliability of their findings. To advance the understanding of this condition and its long-term effects on brain health, the review proposes a series of strategies, including the development of standardized screening tools, the investigation of underlying mechanisms, and the identification of risk factors and protective factors. It also emphasizes the importance of collaborative research efforts and international data sharing platforms in accelerating the pace of discovery and developing targeted interventions for individuals with long COVID. As the prevalence of this condition continues to grow, it is imperative that the neuroscience community comes together to address this challenge and support those affected by long COVID.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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11
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Alim-Marvasti A, Ciocca M, Kuleindiren N, Lin A, Selim H, Mahmud M. Subjective brain fog: a four-dimensional characterization in 25,796 participants. Front Hum Neurosci 2024; 18:1409250. [PMID: 38911226 PMCID: PMC11191638 DOI: 10.3389/fnhum.2024.1409250] [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: 04/02/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Brain fog is associated with significant morbidity and reduced productivity and gained increasing attention after COVID-19. However, this subjective state has not been systematically characterised. Objective To characterise self-reported brain fog. Design We systematically studied the cross-sectional associations between 29 a priori variables with the presence of "brain fog." The variables were grouped into four categories: demographics, symptoms and functional impairments, comorbidities and potential risk factors (including lifestyle factors), and cognitive score. Univariate methods determined the correlates of brain fog, with long-COVID and non-long-COVID subgroups. XGBoost machine learning model retrospectively characterised subjective brain fog. Bonferroni-corrected statistical significance was set at 5%. Setting Digital application for remote data collection. Participants 25,796 individuals over the age of 18 who downloaded and completed the application. Results 7,280 of 25,796 individuals (28.2%) reported experiencing brain fog, who were generally older (mean brain fog 35.7 ± 11.9 years vs. 32.8 ± 11.6 years, p < 0.0001) and more likely to be female (OR = 1.2, p < 0.001). Associated symptoms and functional impairments included difficulty focusing or concentrating (OR = 3.3), feeling irritable (OR = 1.6), difficulty relaxing (OR = 1.2, all p < 0.0001), difficulty following conversations (OR = 2.2), remembering appointments (OR = 1.9), completing paperwork and performing mental arithmetic (ORs = 1.8, all p < 0.0001). Comorbidities included long-COVID-19 (OR = 3.8, p < 0.0001), concussions (OR = 2.4, p < 0.0001), and higher migraine disability assessment scores (MIDAS) (+34.1%, all p < 0.0001). Cognitive scores were marginally lower with brain fog (-0.1 std., p < 0.001). XGBoost achieved a training accuracy of 85% with cross-validated accuracy of 74%, and the features most predictive of brain fog in the model were difficulty focusing and following conversations, long-COVID, and severity of migraines. Conclusions and relevance This is the largest study characterising subjective brain fog as an impairment of concentration associated with functional impairments in activities of daily living. Brain fog was particularly associated with a history of long-COVID-19, migraines, concussion, and with 0.1 standard deviations lower cognitive scores, especially on modified Stroop testing, suggesting impairments in the ability to inhibit cognitive interference. Further prospective studies in unselected brain fog sufferers should explore the full spectrum of brain fog symptoms to differentiate it from its associated conditions.
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Affiliation(s)
- Ali Alim-Marvasti
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Research Division, Mindset Technologies Ltd., London, United Kingdom
| | - Matteo Ciocca
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Aaron Lin
- Research Division, Mindset Technologies Ltd., London, United Kingdom
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd., London, United Kingdom
| | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd., London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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12
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Monteiro S, Dessenne C, Perquin M. Long COVID cognitive sequelae 6 months postinfection and beyond: a scoping review protocol. BMJ Open 2024; 14:e084798. [PMID: 38844389 PMCID: PMC11163643 DOI: 10.1136/bmjopen-2024-084798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION The novel and expanding field of long COVID research has undergone diverse methodological approaches in recent years. This protocol lays out the methodological approach, which aims at identifying nuances in current research. It underscores the necessity for a more precise understanding of prolonged cognitive sequelae and their relation to initial disease severity. The findings will add valuable insights for the development of targeted rehabilitation, healthcare interventions and thereby aid patients, clinicians, policymakers and researchers. Our upcoming research is introduced here. METHODS AND ANALYSIS To map current research in the field, a scoping review will be conducted and documented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review Extension standards. A systematic search of scientific databases (PubMed, EMBASE), presented 1409 eligible results, published up to 21 December 2023. After removal of duplicates, 925 articles were extracted for screening. Two independent reviewers will screen for titles, abstracts and full texts, to extract data, which will then be organised using charting software. Data for various variables, that is, journal info, studied population demographics, study design, long COVID related data, cognitive outcomes and neuropsychological tests will be gathered. Descriptive analyses, evidence gap maps, heat map quantifications and narrative synthesis will be conducted for reporting of results.This scoping review has been registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/JHFX6). ETHICS AND DISSEMINATION Ethical approval is not required, as the study does not involve human participants. The findings will be disseminated through a publication in a scientific journal and within the professional network.
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Affiliation(s)
- Sara Monteiro
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Coralie Dessenne
- Science Office, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Magali Perquin
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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13
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Guillén N, Pérez-Millan A, Falgàs N, Lledó-Ibáñez GM, Rami L, Sarto J, Botí MA, Arnaldos-Pérez C, Ruiz-García R, Naranjo L, Segura B, Balasa M, Sala-Llonch R, Lladó A, Gray SM, Johannesen JK, Pantoni MM, Rutledge GA, Sawant R, Wang Y, Watson LS, Dalmau J, Sanchez-Valle R. Cognitive profile, neuroimaging and fluid biomarkers in post-acute COVID-19 syndrome. Sci Rep 2024; 14:12927. [PMID: 38839833 PMCID: PMC11153491 DOI: 10.1038/s41598-024-63071-2] [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: 11/16/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
We aimed to characterize the cognitive profile of post-acute COVID-19 syndrome (PACS) patients with cognitive complaints, exploring the influence of biological and psychological factors. Participants with confirmed SARS-CoV-2 infection and cognitive complaints ≥ 8 weeks post-acute phase were included. A comprehensive neuropsychological battery (NPS) and health questionnaires were administered at inclusion and at 1, 3 and 6 months. Blood samples were collected at each visit, MRI scan at baseline and at 6 months, and, optionally, cerebrospinal fluid. Cognitive features were analyzed in relation to clinical, neuroimaging, and biochemical markers at inclusion and follow-up. Forty-nine participants, with a mean time from symptom onset of 10.4 months, showed attention-executive function (69%) and verbal memory (39%) impairment. Apathy (64%), moderate-severe anxiety (57%), and severe fatigue (35%) were prevalent. Visual memory (8%) correlated with total gray matter (GM) and subcortical GM volume. Neuronal damage and inflammation markers were within normal limits. Over time, cognitive test scores, depression, apathy, anxiety scores, MRI indexes, and fluid biomarkers remained stable, although fewer participants (50% vs. 75.5%; p = 0.012) exhibited abnormal cognitive evaluations at follow-up. Altered attention/executive and verbal memory, common in PACS, persisted in most subjects without association with structural abnormalities, elevated cytokines, or neuronal damage markers.
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Affiliation(s)
- Núria Guillén
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Agnès Pérez-Millan
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain
- Department of Biomedicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Neus Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | | | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Jordi Sarto
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Maria A Botí
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Cristina Arnaldos-Pérez
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Immunology Service, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Raquel Ruiz-García
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Immunology Service, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Naranjo
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Immunology Service, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Bàrbara Segura
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain
- Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Mircea Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Roser Sala-Llonch
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain
- Department of Biomedicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Yi Wang
- Sage Therapeutics, Cambridge, USA
| | | | - Josep Dalmau
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain
- Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Enfermedades Raras, Centro de Investigación Biomédica en Red, Madrid, Spain
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.
- Fundació Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain.
- Institut de Neurociències, Faculty of Medicine and Medical Sciences, University of Barcelona, Barcelona, Spain.
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14
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Tomasa-Irriguible TM, Monfà R, Miranda-Jiménez C, Morros R, Robert N, Bordejé-Laguna L, Vidal S, Torán-Monserrat P, Barriocanal AM. Preventive Intake of a Multiple Micronutrient Supplement during Mild, Acute SARS-CoV-2 Infection to Reduce the Post-Acute COVID-19 Condition: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Nutrients 2024; 16:1631. [PMID: 38892564 PMCID: PMC11174626 DOI: 10.3390/nu16111631] [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: 04/30/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Patients hospitalized with COVID-19 have low levels of vitamins and trace elements. This could lead to a post-acute COVID-19 condition (PCC) that can worsen a patient's quality of life. We aimed to study the baseline micronutrient status of patients and assess whether a multiple micronutrient supplement (MMS) taken for 2 weeks at the first sign of COVID-19 symptoms would be able to reduce the incidence of PCC. This double-blind, placebo-controlled, randomized clinical trial was conducted in adult outpatients with acute COVID-19, recruited between 2021 and 2023 in Spain. Of the 285 patients assessed for eligibility, 267 were randomized and 246 were included in the intent-to-treat population. The mean age was 46.8 years, and 68% were female. Overall, 54.6% had micronutrient deficiencies in the acute phase of COVID-19 at baseline, and 26.2% had PCC after 180 days of follow-up (D180). The most frequently recorded PCC symptoms were neurological (14.1%), with 24% patients scoring worse in the cognitive tests compared to their baseline status. The rate of PCC at D180 was similar between the placebo (25.0%) and intervention (27.7%) groups, without significant differences (p = 0.785). Age over 50 years was the most relevant risk factor for developing PCC, followed by female sex. The most important protective factor against PCC was SARS-CoV-2 vaccination. In this population of predominantly middle-aged, white women with acute COVID-19 not requiring hospital admission, MMS intake for 14 days at symptom onset did not prevent PCC nor improve their micronutrient status at D180.
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Affiliation(s)
| | - Ramon Monfà
- Jordi Gol University Research Institute in Primary Care (IDIAP Jordi Gol), 08007 Barcelona, Spain; (R.M.); (C.M.-J.)
| | - Cristina Miranda-Jiménez
- Jordi Gol University Research Institute in Primary Care (IDIAP Jordi Gol), 08007 Barcelona, Spain; (R.M.); (C.M.-J.)
| | - Rosa Morros
- Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona (UAB), 08193 Bellaterra, Spain;
| | - Neus Robert
- Emergency Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Luisa Bordejé-Laguna
- Intensive Care Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Sandra Vidal
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain; (S.V.); (A.M.B.)
| | - Pere Torán-Monserrat
- North Metropolitan Research Support Unit, Jordi Gol University Research Institute in Primary Care (NM-IDIAP Jordi Gol), 08303 Mataró, Spain;
| | - Ana Maria Barriocanal
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain; (S.V.); (A.M.B.)
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15
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Hosp JA, Reisert M, Dressing A, Götz V, Kellner E, Mast H, Arndt S, Waller CF, Wagner D, Rieg S, Urbach H, Weiller C, Schröter N, Rau A. Cerebral microstructural alterations in Post-COVID-condition are related to cognitive impairment, olfactory dysfunction and fatigue. Nat Commun 2024; 15:4256. [PMID: 38762609 PMCID: PMC11102465 DOI: 10.1038/s41467-024-48651-0] [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: 04/21/2022] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
After contracting COVID-19, a substantial number of individuals develop a Post-COVID-Condition, marked by neurologic symptoms such as cognitive deficits, olfactory dysfunction, and fatigue. Despite this, biomarkers and pathophysiological understandings of this condition remain limited. Employing magnetic resonance imaging, we conduct a comparative analysis of cerebral microstructure among patients with Post-COVID-Condition, healthy controls, and individuals that contracted COVID-19 without long-term symptoms. We reveal widespread alterations in cerebral microstructure, attributed to a shift in volume from neuronal compartments to free fluid, associated with the severity of the initial infection. Correlating these alterations with cognition, olfaction, and fatigue unveils distinct affected networks, which are in close anatomical-functional relationship with the respective symptoms.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marco Reisert
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Veronika Götz
- Department of Internal Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjörg Mast
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susan Arndt
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius F Waller
- Department of Internal Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Department of Internal Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Department of Internal Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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16
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Ruzicka M, Sachenbacher S, Heimkes F, Uebleis AO, Karch S, Grosse-Wentrup F, Ibarra Fonseca GJ, Wunderlich N, Bogner J, Mayerle J, von Bergwelt-Baildon M, Falkai P, Subklewe M, Ruzicka T, Benesch C, Valdinoci E, Pernpruner A, Thomas A, Heindl B, Stubbe HC, Adorjan K. Characterization of cognitive symptoms in post COVID-19 patients. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01821-z. [PMID: 38739263 DOI: 10.1007/s00406-024-01821-z] [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: 06/16/2023] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Cognitive symptoms (CS) belong to the most common manifestations of the Post COVID-19 (PC) condition. We sought to objectify CS in PC patients using routine diagnostic assessments: neurocognitive testing (NCT) and brain imaging (BI). Further, we investigated possible associations of CS with patient reported outcomes (PROs), and risk factors for developing CS. Clinical data and PROs of 315 PC patients were assessed at a mean of 6 months after SARS-CoV-2 infection. 231 (73.3%) patients reported any sort of CS. Among them, 78 underwent NCT and 55 received BI. In NCT, the cognitive domains most affected were the working memory, attention, and concentration. Nonetheless, pathological thresholds were exceeded only in few cases. Neurocognitive performance did not differ significantly between patients complaining of severe (n = 26) versus non-severe (n = 52) CS. BI findings were abnormal in 8 (14.5%) cases with CS but were most likely not related to PC. Patients reporting high severity of CS scored worse in the PHQ-9, FSS, WHOQOL-BREF, were more likely to report impaired sleep, and had a higher prevalence of psychiatric diagnoses. Overall, NCT could confirm mild impairment in some but not all PC patients with CS, while BI studies were abnormal in only few cases. CS severity did not affect NCT results, but severe CS were associated with symptoms of depression (PHQ-9), fatigue (FSS), reduced quality of life (WHOQOL-BREF) and higher prevalence of psychiatric illnesses. These findings support the importance of NCT, BI, and neuro-psychological assessment in the work-up of PC patients reporting CS. TRIAL REGISTRATION: Trial registration number and date of registration: DRKS00030974, 22 Dec 2022, retrospectively registered.
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Affiliation(s)
- Michael Ruzicka
- Department of Medicine III, Ludwig Maximilian University (LMU) University Hospital, LMU Munich, Munich, Germany.
| | - Simone Sachenbacher
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Fides Heimkes
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Aline Olivia Uebleis
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Fabienne Grosse-Wentrup
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Nora Wunderlich
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, Ludwig Maximilian University (LMU) University Hospital, LMU Munich, Munich, Germany
| | - Thomas Ruzicka
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Christopher Benesch
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elisabeth Valdinoci
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Pernpruner
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anabel Thomas
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Heindl
- Stabstelle Strategische Unternehmenssteuerung, LMU Munich, Munich, Germany
| | | | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
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17
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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 PMCID: PMC11288549 DOI: 10.3174/ajnr.a8167] [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: 09/19/2023] [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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18
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Mohammadi S, Ghaderi S. Post-COVID-19 conditions: a systematic review on advanced magnetic resonance neuroimaging findings. Neurol Sci 2024; 45:1815-1833. [PMID: 38421524 DOI: 10.1007/s10072-024-07427-6] [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: 11/30/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Post-COVID conditions (PCCs) cover a wide spectrum of lingering symptoms experienced by survivors of coronavirus disease 2019 (COVID-19). Neurological and neuropsychiatric sequelae are common in PCCs. Advanced magnetic resonance imaging (MRI) techniques can reveal subtle alterations in brain structure, function, and perfusion that underlie these sequelae. This systematic review aimed to synthesize findings from studies that used advanced MRI to characterize brain changes in individuals with PCCs. A detailed literature search was conducted in the PubMed and Scopus databases to identify relevant studies that used advanced MRI modalities, such as structural MRI (sMRI), diffusion tensor imaging (DTI), functional MRI (fMRI), and perfusion-weighted imaging (PWI), to evaluate brain changes in PCCs. Twenty-five studies met the inclusion criteria, comprising 1219 participants with PCCs. The most consistent findings from sMRI were reduced gray matter volume (GMV) and cortical thickness (CTh) in cortical and subcortical regions. DTI frequently reveals increased mean diffusivity (MD), radial diffusivity (RD), and decreased fractional anisotropy (FA) in white matter tracts (WMTs) such as the corpus callosum, corona radiata, and superior longitudinal fasciculus. fMRI demonstrated altered functional connectivity (FC) within the default mode, salience, frontoparietal, somatomotor, subcortical, and cerebellar networks. PWI showed decreased cerebral blood flow (CBF) in the frontotemporal area, thalamus, and basal ganglia. Advanced MRI shows changes in the brain networks and regions of the PCCs, which may cause neurological and neuropsychiatric problems. Multimodal neuroimaging may help understand brain-behavior relationships. Longitudinal studies are necessary to better understand the progression of these brain anomalies.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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19
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Delgado-Alonso C, Delgado-Alvarez A, Díez-Cirarda M, Oliver-Mas S, Cuevas C, Montero-Escribano P, Ramos-Leví AM, Gil-Moreno MJ, López-Carbonero JI, Hermann BP, Matias-Guiu J, Matias-Guiu JA. Cognitive profile in multiple sclerosis and post-COVID condition: a comparative study using a unified taxonomy. Sci Rep 2024; 14:9806. [PMID: 38684843 PMCID: PMC11059260 DOI: 10.1038/s41598-024-60368-0] [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: 06/29/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
Post-COVID condition (PCC) and multiple sclerosis (MS) share some clinical and demographic features, including cognitive symptoms and fatigue. Some pathophysiological mechanisms well-known in MS, such as autoimmunity, neuroinflammation and myelin damage, have also been implicated in PCC. In this study, we aimed to compare the cognitive phenotypes of two large cohorts of patients with PCC and MS, and to evaluate the relationship between fatigue and cognitive performance. Cross-sectional study including 218 patients with PCC and 218 with MS matched by age, sex, and years of education. Patients were evaluated with a comprehensive neuropsychological protocol and were categorized according to the International Classification of Cognitive Disorders system. Fatigue and depression were also assessed. Cognitive profiles of PCC and MS largely overlapped, with a greater impairment in episodic memory in MS, but with small effect sizes. The most salient deficits in both disorders were in attention and processing speed. The severity of fatigue was greater in patients with PCC. Still, the correlations between fatigue severity and neuropsychological tests were more prominent in the case of MS. There were no differences in the severity of depression among groups. Our study found similar cognitive profiles in PCC and MS. Fatigue was more severe in PCC, but was more associated with cognitive performance in MS. Further comparative studies addressing the mechanisms related to cognitive dysfunction and fatigue may be of interest to advance the knowledge of these disorders and develop new therapies.
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Affiliation(s)
- Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Alfonso Delgado-Alvarez
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Silvia Oliver-Mas
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Constanza Cuevas
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Paloma Montero-Escribano
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Ana Maria Ramos-Leví
- Department of Endocrinology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Juan Ignacio López-Carbonero
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jorge Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain.
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20
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Sun Z, Shi C, Jin L. Mechanisms by Which SARS-CoV-2 Invades and Damages the Central Nervous System: Apart from the Immune Response and Inflammatory Storm, What Else Do We Know? Viruses 2024; 16:663. [PMID: 38793545 PMCID: PMC11125732 DOI: 10.3390/v16050663] [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: 01/30/2024] [Revised: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Initially reported as pneumonia of unknown origin, COVID-19 is increasingly being recognized for its impact on the nervous system, despite nervous system invasions being extremely rare. As a result, numerous studies have been conducted to elucidate the mechanisms of nervous system damage and propose appropriate coping strategies. This review summarizes the mechanisms by which SARS-CoV-2 invades and damages the central nervous system, with a specific focus on aspects apart from the immune response and inflammatory storm. The latest research findings on these mechanisms are presented, providing new insights for further in-depth research.
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Affiliation(s)
- Zihan Sun
- Qingdao Medical College, Qingdao University, Qingdao 266071, China
| | - Chunying Shi
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
| | - Lixin Jin
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
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21
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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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22
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Zhao J, Xia F, Jiao X, Lyu X. Long COVID and its association with neurodegenerative diseases: pathogenesis, neuroimaging, and treatment. Front Neurol 2024; 15:1367974. [PMID: 38638307 PMCID: PMC11024438 DOI: 10.3389/fneur.2024.1367974] [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: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 04/20/2024] Open
Abstract
Corona Virus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has presented unprecedented challenges to the world. Changes after acute COVID-19 have had a significant impact on patients with neurodegenerative diseases. This study aims to explore the mechanism of neurodegenerative diseases by examining the main pathways of central nervous system infection of SARS-CoV-2. Research has indicated that chronic inflammation and abnormal immune response are the primary factors leading to neuronal damage and long-term consequences of COVID-19. In some COVID-19 patients, the concurrent inflammatory response leads to increased release of pro-inflammatory cytokines, which may significantly impact the prognosis. Molecular imaging can accurately assess the severity of neurodegenerative diseases in patients with COVID-19 after the acute phase. Furthermore, the use of FDG-PET is advocated to quantify the relationship between neuroinflammation and psychiatric and cognitive symptoms in patients who have recovered from COVID-19. Future development should focus on aggressive post-infection control of inflammation and the development of targeted therapies that target ACE2 receptors, ERK1/2, and Ca2+.
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Affiliation(s)
- Jinyang Zhao
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Fan Xia
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xue Jiao
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xiaohong Lyu
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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23
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Zayeri ZD, Torabizadeh M, Kargar M, Kazemi H. The molecular fingerprint of neuroinflammation in COVID-19: A comprehensive discussion on molecular mechanisms of neuroinflammation due to SARS-COV2 antigens. Behav Brain Res 2024; 462:114868. [PMID: 38246395 DOI: 10.1016/j.bbr.2024.114868] [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: 08/27/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Severe acute respiratory syndrome coronavirus 2 attacks the neural system directly and indirectly via various systems, such as the nasal cavity, olfactory system, and facial nerves. Considering the high energy requirement, lack of antioxidant defenses, and high amounts of metal ions in the brain, oxidative damage is very harmful to the brain. Various neuropathic pain conditions, neurological disorders, and neuropsychiatric complications were reported in Coronavirus disease 2019, prolonged Coronavirus disease 2019, and after Coronavirus disease 2019 immunization. This manuscript offers a distinctive outlook on the interconnectedness between neurology and neuropsychiatry through its meticulous analysis of complications. DISCUSSION After recovering from Coronavirus disease 2019, approximately half of the patients reported developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Long Coronavirus disease 2019 imaging reports illustrated the hypometabolism in various parts of the brain, such as olfactory bulbs, limbic/paralimbic domains, the brainstem, and the cerebellum. Ninety imaging and neuropathological studies of Coronavirus disease 2019 have shown evidence of white matter, brainstem, frontotemporal, and oculofrontal lesions. Emotional functions, such as pleasant, long/short-term memory, movement, cognition and cognition in decision-making are controlled by these regions. The neuroinflammation and the mechanisms of defense are well presented in the discussion. The role of microglia activation, Inducible NO synthase, Cyclooxygenases ½, Reactive oxygen species, neurotoxic toxins and pro-inflammatory cytokines, such as Interleukin-1 beta, Interleukin-6 and Tumor Necrosis Factor-alpha are highlighted in neuronal dysfunction and death. Nuclear factor kappa-light-chain-enhancer of activated B cells, Mitogen-activated protein kinase, Activator Protein 1, and Interferon regulatory factors are the main pathways involved in microglia activation in Coronavirus disease 2019 neuroinflammation. CONCLUSION The neurological aspect of Coronavirus disease 2019 should be highlighted. Neurological, psychological, and behavioral aspects of Coronavirus disease 2019, prolonged Coronavirus disease 2019, and Coronavirus disease 2019 vaccines can be the upcoming issues. We need a global awareness where this aspect of the disease should be more considered in health research.
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Affiliation(s)
- Zeinab Deris Zayeri
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mehdi Torabizadeh
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoud Kargar
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hashem Kazemi
- Department of Biology, Dezful Branch, Islamic Azad University, Dezful, Iran
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24
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Sharma AA, Nenert R, Goodman AM, Szaflarski JP. Brain temperature and free water increases after mild COVID-19 infection. Sci Rep 2024; 14:7450. [PMID: 38548815 PMCID: PMC10978935 DOI: 10.1038/s41598-024-57561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
The pathophysiology underlying the post-acute sequelae of COVID-19 remains understudied and poorly understood, particularly in healthy adults with a history of mild infection. Chronic neuroinflammation may underlie these enduring symptoms, but studying neuroinflammatory phenomena in vivo is challenging, especially without a comparable pre-COVID-19 dataset. In this study, we present a unique dataset of 10 otherwise healthy individuals scanned before and after experiencing mild COVID-19. Two emerging MR-based methods were used to map pre- to post-COVID-19 brain temperature and free water changes. Post-COVID-19 brain temperature and free water increases, which are indirect biomarkers of neuroinflammation, were found in structures functionally associated with olfactory, cognitive, and memory processing. The largest pre- to post-COVID brain temperature increase was observed in the left olfactory tubercle (p = 0.007, 95% CI [0.48, 3.01]), with a mean increase of 1.75 °C. Notably, the olfactory tubercle is also the region of the primary olfactory cortex where participants with chronic olfactory dysfunction showed the most pronounced increases as compared to those without lingering olfactory dysfunction (adjusted pFDR = 0.0189, 95% CI [1.42, 5.27]). These preliminary insights suggest a potential link between neuroinflammation and chronic cognitive and olfactory dysfunction following mild COVID-19, although further investigations are needed to improve our understanding of what underlies these phenomena.
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Affiliation(s)
- Ayushe A Sharma
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA.
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA
| | - Adam M Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA.
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, USA.
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25
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McClelland AC, Benitez SJ, Burns J. COVID-19 Neuroimaging Update: Pathophysiology, Acute Findings, and Post-Acute Developments. Semin Ultrasound CT MR 2024:S0887-2171(24)00026-X. [PMID: 38518814 DOI: 10.1053/j.sult.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
COVID-19 has prominent effects on the nervous system with important manifestations on neuroimaging. In this review, we discuss the neuroimaging appearance of acute COVID-19 that became evident during the early stages of the pandemic. We highlight the underlying pathophysiology mediating nervous system effects and neuroimaging appearances including systemic inflammatory response such as cytokine storm, coagulopathy, and para/post-infections immune mediated phenomena. We also discuss the nervous system manifestations of COVID-19 and the role of imaging as the pandemic has evolved over time, including related to the development of vaccines and the emergence of post-acute sequalae such as long COVID.
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Affiliation(s)
| | - Steven J Benitez
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Judah Burns
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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26
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Mohammadi S, Ghaderi S. Advanced magnetic resonance neuroimaging techniques: feasibility and applications in long or post-COVID-19 syndrome - a review. Ann Med Surg (Lond) 2024; 86:1584-1589. [PMID: 38463042 PMCID: PMC10923379 DOI: 10.1097/ms9.0000000000001808] [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: 11/16/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Long-term or post-COVID-19 syndrome (PCS) is a condition that affects people infected with SARS‑CoV‑2, the virus that causes COVID-19. PCS is characterized by a wide range of persistent or new symptoms that last months after the initial infection, such as fatigue, shortness of breath, cognitive dysfunction, and pain. Advanced magnetic resonance (MR) neuroimaging techniques can provide valuable information on the structural and functional changes in the brain associated with PCS as well as potential biomarkers for diagnosis and prognosis. In this review, we discuss the feasibility and applications of various advanced MR neuroimaging techniques in PCS, including perfusion-weighted imaging (PWI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), functional MR imaging (fMRI), diffusion tensor imaging (DTI), and tractography. We summarize the current evidence on neuroimaging findings in PCS, the challenges and limitations of these techniques, and the future directions for research and clinical practice. Although still uncertain, advanced MRI techniques show promise for gaining insight into the pathophysiology and guiding the management of COVID-19 syndrome, pending larger validation studies.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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27
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Romero-Molina AO, Ramirez-Garcia G, Chirino-Perez A, Fuentes-Zavaleta DA, Hernandez-Castillo CR, Marrufo-Melendez O, Lopez-Gonzalez D, Rodriguez-Rodriguez M, Castorena-Maldonado A, Rodriguez-Agudelo Y, Paz-Rodriguez F, Chavez-Oliveros M, Lozano-Tovar S, Gutierrez-Romero A, Arauz-Gongora A, Garcia-Santos RA, Fernandez-Ruiz J. SARS-CoV-2's brain impact: revealing cortical and cerebellar differences via cluster analysis in COVID-19 recovered patients. Neurol Sci 2024; 45:837-848. [PMID: 38172414 DOI: 10.1007/s10072-023-07266-x] [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: 10/12/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND COVID-19 is a disease known for its neurological involvement. SARS-CoV-2 infection triggers neuroinflammation, which could significantly contribute to the development of long-term neurological symptoms and structural alterations in the gray matter. However, the existence of a consistent pattern of cerebral atrophy remains uncertain. OBJECTIVE Our study aimed to identify patterns of brain involvement in recovered COVID-19 patients and explore potential relationships with clinical variables during hospitalization. METHODOLOGY In this study, we included 39 recovered patients and 39 controls from a pre-pandemic database to ensure their non-exposure to the virus. We obtained clinical data of the patients during hospitalization, and 3 months later; in addition we obtained T1-weighted magnetic resonance images and performed standard screening cognitive tests. RESULTS We identified two groups of recovered patients based on a cluster analysis of the significant cortical thickness differences between patients and controls. Group 1 displayed significant cortical thickness differences in specific cerebral regions, while Group 2 exhibited significant differences in the cerebellum, though neither group showed cognitive deterioration at the group level. Notably, Group 1 showed a tendency of higher D-dimer values during hospitalization compared to Group 2, prior to p-value correction. CONCLUSION This data-driven division into two groups based on the brain structural differences, and the possible link to D-dimer values may provide insights into the underlying mechanisms of SARS-COV-2 neurological disruption and its impact on the brain during and after recovery from the disease.
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Affiliation(s)
- Angel Omar Romero-Molina
- Instituto de Neuroetologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Gabriel Ramirez-Garcia
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Amanda Chirino-Perez
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juan Fernandez-Ruiz
- Instituto de Neuroetologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
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28
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Hampshire A, Azor A, Atchison C, Trender W, Hellyer PJ, Giunchiglia V, Husain M, Cooke GS, Cooper E, Lound A, Donnelly CA, Chadeau-Hyam M, Ward H, Elliott P. Cognition and Memory after Covid-19 in a Large Community Sample. N Engl J Med 2024; 390:806-818. [PMID: 38416429 PMCID: PMC7615803 DOI: 10.1056/nejmoa2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear. METHODS We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating ("brain fog"). RESULTS Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no-Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (-0.23 SD [95% confidence interval {CI}, -0.33 to -0.13] and -0.24 SD [95% CI, -0.36 to -0.12], respectively); larger deficits as compared with the no-Covid-19 group were seen in participants with unresolved persistent symptoms (-0.42 SD; 95% CI, -0.53 to -0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., -0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, -0.20 to -0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, -0.35 SD; 95% CI, -0.49 to -0.20). Results of the analyses were similar to those of propensity-score-matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no-Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (-0.33 to -0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported. CONCLUSIONS Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.).
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Affiliation(s)
- Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Adriana Azor
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | | | - Masud Husain
- Nuffield Dept Clinical Neurosciences & Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Graham S. Cooke
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Emily Cooper
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Adam Lound
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Christl A. Donnelly
- School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Marc Chadeau-Hyam
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Health Data Research UK London at Imperial, London UK
- UK Dementia Research Institute at Imperial, London UK
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Bungenberg J, Hohenfeld C, Costa AS, Heine J, Schwichtenberg K, Hartung T, Franke C, Binkofski F, Schulz JB, Finke C, Reetz K. Characteristic functional connectome related to Post-COVID-19 syndrome. Sci Rep 2024; 14:4997. [PMID: 38424415 PMCID: PMC10904373 DOI: 10.1038/s41598-024-54554-3] [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: 07/31/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Post-COVID-19 syndrome is a serious complication following SARS-CoV-2 infection, characterized primarily by fatigue and cognitive complaints. Although first metabolic and structural imaging alterations in Post-COVID-19 syndrome have been identified, their functional consequences remain unknown. Thus, we explored the impact of Post-COVID-19 syndrome on the functional connectome of the brain providing a deeper understanding of pathophysiological mechanisms. In a cross-sectional observational study, resting-state functional magnetic resonance imaging data of 66 patients with Post-COVID-19 syndrome after mild infection (mean age 42.3 years, 57 female) and 57 healthy controls (mean age 42.1 years, 38 female) with a mean time of seven months after acute COVID-19 were analysed using a graph theoretical approach. Network features were quantified using measures including mean distance, nodal degree, betweenness and Katz centrality, and compared between both groups. Graph measures were correlated with clinical measures quantifying fatigue, cognitive function, affective symptoms and sleep disturbances. Alterations were mainly found in the brainstem, olfactory cortex, cingulate cortex, thalamus and cerebellum on average seven months after SARS-CoV-2 infection. Additionally, strong correlations between fatigue severity, cognitive functioning and daytime sleepiness from clinical scales and graph measures were observed. Our study confirms functional relevance of brain imaging changes in Post-COVID-19 syndrome as mediating factors for persistent symptoms and improves our pathophysiological understanding.
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Affiliation(s)
- Julia Bungenberg
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Christian Hohenfeld
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Ana S Costa
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Josephine Heine
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Katia Schwichtenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Tim Hartung
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Christiana Franke
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Ferdinand Binkofski
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Division for Clinical Cognitive Sciences, Department of Neurology, RWTH Aachen University, 52074, Aachen, Germany
- Institute for Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, 52425, Jülich, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Carsten Finke
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany.
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Peixoto VGMNP, Facci LA, Barbalho TCS, Souza RN, Duarte AM, dos Santos MB, Almondes KM. Factors associated with older adults' cognitive decline 6 months after gamma-variant SARS-CoV-2 infection. Front Neurol 2024; 15:1334161. [PMID: 38426174 PMCID: PMC10902427 DOI: 10.3389/fneur.2024.1334161] [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: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Cognitive deficits are commonly reported after COVID-19 recovery, but little is known in the older population. This study aims to investigate possible cognitive damage in older adults 6 months after contracting COVID-19, as well as individual risk factors. Methods This cross-sectional study involved 70 participants aged 60-78 with COVID-19 6 months prior and 153 healthy controls. Montreal Cognitive Assessment-Basic (MoCA-B) screened for cognitive impairment; Geriatric Depression Scale and Geriatric Anxiety Inventory screened for depression and anxiety. Data were collected on demographics and self-reports of comorbid conditions. Results The mean age of participants was 66.97 ± 4.64 years. A higher proportion of individuals in the COVID group complained about cognitive deficits (χ2 = 3.574; p = 0.029) and presented with deficient MoCA-B scores (χ2 = 6.098, p = 0.014) compared to controls. After controlling for multiple variables, all the following factors resulted in greater odds of a deficient MoCA-B: COVID-19 6-months prior (OR, 2.44; p = 0.018), age (OR, 1.15; p < 0.001), lower income (OR, 0.36; p = 0.070), and overweight (OR, 2.83; p = 0.013). Further analysis pointed to individual characteristics in COVID-19-affected patients that could explain the severity of the cognitive decline: age (p = 0.015), lower income (p < 0.001), anxiety (p = 0.049), ageusia (p = 0.054), overweight (p < 0.001), and absence of cognitively stimulating activities (p = 0.062). Conclusion Our study highlights a profile of cognitive risk aggravation over aging after COVID-19 infection, which is likely mitigated by wealth but worsened in the presence of overweight. Ageusia at the time of acute COVID-19, anxiety, being overweight, and absence of routine intellectual activities are risk factors for more prominent cognitive decline among those infected by COVID-19.
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Affiliation(s)
- Vanessa Giffoni M. N. P. Peixoto
- Post-graduation Program in Psychobiology, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Department of Clinical Medicine, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | | | | | - Katie Moraes Almondes
- Post-graduation Program in Psychobiology, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Department of Psychology, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Gaber MM, Hosny H, Hussein M, Ashmawy MA, Magdy R. Cognitive function and quantitative electroencephalogram analysis in subjects recovered from COVID-19 infection. BMC Neurol 2024; 24:60. [PMID: 38336659 PMCID: PMC10858500 DOI: 10.1186/s12883-023-03518-7] [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: 09/08/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND & OBJECTIVES Objective assessment of post-COVID-19 cognitive dysfunction is highly warranted. This study aimed to evaluate the cognitive dysfunction of COVID-19 survivors with cognitive complaints, both clinically and neurophysiologically, using Quantitative Electroencephalogram (QEEG). METHODS This case-control study was conducted on 50 recovered subjects from COVID-19 infection with cognitive complaints and 50 age, sex, and educational-matched healthy controls. Both groups were subjected to the following neurocognitive tests: Paired associate learning Test (PALT) and Paced Auditory Serial Addition Test (PASAT). The neurophysiological assessment was also done for both groups using QEEG. RESULTS COVID-19 survivors had significantly lower PALT scores than controls (P < 0.001). QEEG analysis found significantly higher levels of Theta / Beta ratio in both central and parietal areas in patients than in the controls (P < 0.001 for each). The interhemispheric coherence for the frontal, central, and parietal regions was also significantly lower in patients than in the control group regarding alpha and beta bands. There were statistically significant lower scores of PALT and PASAT among cases with severe COVID-19 infection (P = 0.011, 0.005, respectively) and those who needed oxygen support (P = 0.04, 0.01, respectively). On the other hand, a statistically significantly lower mean of frontal alpha inter-hemispheric coherence among patients with severe COVID-19 infection (P = 0.01) and those needing mechanical ventilation support (P = 0.04). CONCLUSION Episodic memory deficit is evident in COVID-19 survivors with subjective cognitive complaints accompanied by lower inter-hemispheric coherence in frontal regions. These clinical and neurophysiological changes are associated with hypoxia and COVID-19 severity.
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Affiliation(s)
- Manal M Gaber
- Clinical Neurophysiology Department, Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Beni-Suef, Egypt
| | - Hanan Hosny
- Clinical Neurophysiology Department, Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Beni-Suef, Egypt
| | - Mona Hussein
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mona A Ashmawy
- Clinical Neurophysiology Department, Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Zhang S, Yuan M, He D, Dang W, Zhang W. Long-term follow-up of brain regional changes and the association with cognitive impairment in quarantined COVID-19 survivors. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01741-4. [PMID: 38319396 DOI: 10.1007/s00406-023-01741-4] [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: 07/05/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This study aimed to evaluate the neuropsychiatric symptoms of quarantined COVID-19 survivors 15 months after discharge and explore its potential association with structural and functional brain changes and inflammation. METHODS A total of 51 quarantined COVID-19 survivors and 74 healthy controls were included in this study. Cognitive function was assessed using the THINC-integrated tool. Structural brain changes were examined through both surface- and volume-based analyses, and functional changes were assessed using resting-state amplitude low-frequency fluctuation (ALFF). Serum inflammatory markers were measured by a multiplexed flow cytometric assay. RESULTS COVID-19 survivors exhibited subjective cognitive decline compared to healthy controls, despite no significant differences in objective cognitive tasks. Structural analysis revealed significantly increased gray matter volume and cortical surface area in the left transverse temporal gyrus (Heschl's gyrus) in quarantined COVID-19 survivors. This enlargement was negatively correlated with cognitive impairment. The ALFF analysis showed decreased neural activity in multiple brain regions. Elevated levels of serum inflammatory markers were also found in COVID-19 survivors, including MIP-1a, MIP-1b, TNF-a, and IL-8, which correlated with functional abnormalities. CONCLUSIONS Our findings indicate a subjective cognitive decline in quarantined COVID-19 survivors 15 months after discharge, which is associated with brain structural alterations in the left Heschl's gyrus. The observed elevation of inflammatory markers suggests a potential mechanism involving inflammation-induced neurogenesis. These results contribute to our understanding of the possible mechanisms underlying long-term neuropsychiatric consequences of COVID-19 and highlight the need for further research to develop targeted interventions.
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Affiliation(s)
- Simai Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Minlan Yuan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Danmei He
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wen Dang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China.
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Vakani K, Ratto M, Sandford-James A, Antonova E, Kumari V. Cognitive and mental health trajectories of COVID-19: Role of hospitalisation and long-COVID symptoms. Eur Psychiatry 2024; 67:e17. [PMID: 38312039 DOI: 10.1192/j.eurpsy.2024.7] [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: 02/06/2024] Open
Abstract
BACKGROUND There is considerable evidence of cognitive impairment post COVID-19, especially in individuals with long-COVID symptoms, but limited research objectively evaluating whether such impairment attenuates or resolves over time, especially in young and middle-aged adults. METHODS Follow-up assessments (T2) of cognitive function (processing speed, attention, working memory, executive function, memory) and mental health were conducted in 138 adults (18-69 years) who had been assessed 6 months earlier (T1). Of these, 88 had a confirmed history of COVID-19 at T1 assessment (≥20 days post-diagnosis) and were also followed-up on COVID-19-related symptoms (acute and long-COVID); 50 adults had no known COVID-19 history at any point up to their T2 assessment. RESULTS From T1 to T2, a trend-level improvement occurred in intra-individual variability in processing speed in the COVID, relative to the non-COVID group. However, longer response/task completion times persisted in participants with COVID-19-related hospitalisation relative to those without COVID-19-related hospitalisation and non-COVID controls. There was a significant reduction in long-COVID symptom load, which correlated with improved executive function in non-hospitalised COVID-19 participants. The COVID group continued to self-report poorer mental health, irrespective of hospitalisation history, relative to non-COVID group. CONCLUSIONS Although some cognitive improvement has occurred over a 6-month period in young and middle-aged COVID-19 survivors, cognitive impairment persists in those with a history of COVID-19-related hospitalisation and/or long-COVID symptoms. Continuous follow-up assessments are required to determine whether cognitive function improves or possibly worsens, over time in hospitalised and long-COVID participants.
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Affiliation(s)
- Krupa Vakani
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | | | | | - Elena Antonova
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Veena Kumari
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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Jaywant A, Gunning FM, Oberlin LE, Santillana M, Ognyanova K, Druckman JN, Baum MA, Lazer D, Perlis RH. Cognitive Symptoms of Post-COVID-19 Condition and Daily Functioning. JAMA Netw Open 2024; 7:e2356098. [PMID: 38353947 PMCID: PMC10867690 DOI: 10.1001/jamanetworkopen.2023.56098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
Importance The frequent occurrence of cognitive symptoms in post-COVID-19 condition has been described, but the nature of these symptoms and their demographic and functional factors are not well characterized in generalizable populations. Objective To investigate the prevalence of self-reported cognitive symptoms in post-COVID-19 condition, in comparison with individuals with prior acute SARS-CoV-2 infection who did not develop post-COVID-19 condition, and their association with other individual features, including depressive symptoms and functional status. Design, Setting, and Participants Two waves of a 50-state nonprobability population-based internet survey conducted between December 22, 2022, and May 5, 2023. Participants included survey respondents aged 18 years and older. Exposure Post-COVID-19 condition, defined as self-report of symptoms attributed to COVID-19 beyond 2 months after the initial month of illness. Main Outcomes and Measures Seven items from the Neuro-QoL cognition battery assessing the frequency of cognitive symptoms in the past week and patient Health Questionnaire-9. Results The 14 767 individuals reporting test-confirmed COVID-19 illness at least 2 months before the survey had a mean (SD) age of 44.6 (16.3) years; 568 (3.8%) were Asian, 1484 (10.0%) were Black, 1408 (9.5%) were Hispanic, and 10 811 (73.2%) were White. A total of 10 037 respondents (68.0%) were women and 4730 (32.0%) were men. Of the 1683 individuals reporting post-COVID-19 condition, 955 (56.7%) reported at least 1 cognitive symptom experienced daily, compared with 3552 of 13 084 (27.1%) of those who did not report post-COVID-19 condition. More daily cognitive symptoms were associated with a greater likelihood of reporting at least moderate interference with functioning (unadjusted odds ratio [OR], 1.31 [95% CI, 1.25-1.36]; adjusted [AOR], 1.30 [95% CI, 1.25-1.36]), lesser likelihood of full-time employment (unadjusted OR, 0.95 [95% CI, 0.91-0.99]; AOR, 0.92 [95% CI, 0.88-0.96]) and greater severity of depressive symptoms (unadjusted coefficient, 1.40 [95% CI, 1.29-1.51]; adjusted coefficient 1.27 [95% CI, 1.17-1.38). After including depressive symptoms in regression models, associations were also found between cognitive symptoms and at least moderate interference with everyday functioning (AOR, 1.27 [95% CI, 1.21-1.33]) and between cognitive symptoms and lower odds of full-time employment (AOR, 0.92 [95% CI, 0.88-0.97]). Conclusions and Relevance The findings of this survey study of US adults suggest that cognitive symptoms are common among individuals with post-COVID-19 condition and associated with greater self-reported functional impairment, lesser likelihood of full-time employment, and greater depressive symptom severity. Screening for and addressing cognitive symptoms is an important component of the public health response to post-COVID-19 condition.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Lauren E. Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Mauricio Santillana
- Machine Intelligence Group for the Betterment of Health and the Environment, Northeastern University, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Ognyanova
- Department of Communication, School of Communication and Information, Rutgers University, New Brunswick, New Jersey
| | - James N. Druckman
- Department of Political Science, University of Rochester, Rochester, New York
| | - Matthew A. Baum
- John F. Kennedy School of Government and Department of Government, Harvard University, Cambridge, Massachusetts
| | - David Lazer
- Network Science Institute, Northeastern University, Boston, Massachusetts
- Department of Political Science, Northeastern University, Boston, Massachusetts
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
- Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Zhao S, Martin EM, Reuken PA, Scholcz A, Ganse-Dumrath A, Srowig A, Utech I, Kozik V, Radscheidt M, Brodoehl S, Stallmach A, Schwab M, Fraser E, Finke K, Husain M. Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study. EClinicalMedicine 2024; 68:102434. [PMID: 38318123 PMCID: PMC10839583 DOI: 10.1016/j.eclinm.2024.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Background COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing. Methods To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK. Findings We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention. Interpretation Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC. Funding Wellcome Trust (206330/Z/17/Z), NIHR Oxford Health Biomedical Research Centre, the Thüringer Aufbaubank (2021 FGI 0060), German Forschungsgemeinschaft (DFG, FI 1424/2-1) and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890).
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Affiliation(s)
- Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
| | - Eva Maria Martin
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Philipp A. Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Anna Scholcz
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Akke Ganse-Dumrath
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Annie Srowig
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Isabelle Utech
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Valeska Kozik
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Stefan Brodoehl
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Emily Fraser
- Oxfordshire Post-COVID Assessment Clinic, Oxford University Hospitals Foundation NHS Trust, Oxford, UK
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Psychology, LMU Munich, Munich, Germany
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
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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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Scardua-Silva L, Amorim da Costa B, Karmann Aventurato Í, Batista Joao R, Machado de Campos B, Rabelo de Brito M, Bechelli JF, Santos Silva LC, Ferreira Dos Santos A, Koutsodontis Machado Alvim M, Vieira Nunes Ludwig G, Rocha C, Kaue Alves Silva Souza T, Mendes MJ, Waku T, de Oliveira Boldrini V, Silva Brunetti N, Nora Baptista S, da Silva Schmitt G, Duarte de Sousa JG, Marchiori de Oliveira Cardoso TA, Schwambach Vieira A, Barbosa Santos LM, Dos Santos Farias A, Nogueira MH, Cendes F, Lin Yasuda C. Microstructural brain abnormalities, fatigue, and cognitive dysfunction after mild COVID-19. Sci Rep 2024; 14:1758. [PMID: 38242927 PMCID: PMC10798999 DOI: 10.1038/s41598-024-52005-7] [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: 12/03/2022] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
Although some studies have shown neuroimaging and neuropsychological alterations in post-COVID-19 patients, fewer combined neuroimaging and neuropsychology evaluations of individuals who presented a mild acute infection. Here we investigated cognitive dysfunction and brain changes in a group of mildly infected individuals. We conducted a cross-sectional study of 97 consecutive subjects (median age of 41 years) without current or history of psychiatric symptoms (including anxiety and depression) after a mild infection, with a median of 79 days (and mean of 97 days) after diagnosis of COVID-19. We performed semi-structured interviews, neurological examinations, 3T-MRI scans, and neuropsychological assessments. For MRI analyses, we included a group of non-infected 77 controls. The MRI study included white matter (WM) investigation with diffusion tensor images (DTI) and functional connectivity with resting-state functional MRI (RS-fMRI). The patients reported memory loss (36%), fatigue (31%) and headache (29%). The quantitative analyses confirmed symptoms of fatigue (83% of participants), excessive somnolence (35%), impaired phonemic verbal fluency (21%), impaired verbal categorical fluency (13%) and impaired logical memory immediate recall (16%). The WM analyses with DTI revealed higher axial diffusivity values in post-infected patients compared to controls. Compared to controls, there were no significant differences in the functional connectivity of the posterior cingulum cortex. There were no significant correlations between neuropsychological scores and neuroimaging features (including DTI and RS-fMRI). Our results suggest persistent cognitive impairment and subtle white matter abnormalities in individuals mildly infected without anxiety or depression symptoms. The longitudinal analyses will clarify whether these alterations are temporary or permanent.
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Affiliation(s)
- Lucas Scardua-Silva
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Beatriz Amorim da Costa
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Ítalo Karmann Aventurato
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Rafael Batista Joao
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Brunno Machado de Campos
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
| | - Mariana Rabelo de Brito
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - José Flávio Bechelli
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Leila Camila Santos Silva
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Alan Ferreira Dos Santos
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Marina Koutsodontis Machado Alvim
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Guilherme Vieira Nunes Ludwig
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, Brazil
| | - Cristiane Rocha
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Molecular Genetics Laboratory, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Thierry Kaue Alves Silva Souza
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Maria Julia Mendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Takeshi Waku
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
| | | | | | - Sophia Nora Baptista
- Autoimmune Research Lab, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | | | | | - André Schwambach Vieira
- Molecular Genetics Laboratory, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Autoimmune Research Lab, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | | | - Mateus Henrique Nogueira
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
| | - Fernando Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
| | - Clarissa Lin Yasuda
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
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Clouston S, Huang C, Ying J, Sekendiz Z, Kritikos M, Fontana A, Bangiyev L, Luft B. Neuroinflammatory imaging markers in white matter: insights into the cerebral consequences of post-acute sequelae of COVID-19 (PASC). RESEARCH SQUARE 2024:rs.3.rs-3760289. [PMID: 38313257 PMCID: PMC10836117 DOI: 10.21203/rs.3.rs-3760289/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Symptoms of coronavirus disease 2019 (COVID-19) can persist for months or years after infection, a condition called Post-Acute Sequelae of COVID-19 (PASC). Whole-brain white matter and cortical gray matter health were assessed using multi-shell diffusion tensor imaging. Correlational tractography was utilized to dissect the nature and extent of white matter changes. In this study of 42 male essential workers, the most common symptoms of Neurological PASC (n = 24) included fatigue (n = 19) and headache (n = 17). Participants with neurological PASC demonstrated alterations to whole-brain white matter health when compared to controls made up of uninfected, asymptomatic, or mildly infected controls (n = 18). Large differences were evident between PASC and controls in measures of fractional anisotropy (Cohen's D=-0.54, P = 0.001) and cortical isotropic diffusion (Cohen's D = 0.50, P = 0.002). Symptoms were associated with white matter fractional anisotropy (fatigue: rho = -0.62, P< 0.001; headache: rho = -0.66, P < 0.001), as well as nine other measures of white and gray matter health. Brain fog was associated with improved cerebral functioning including improved white matter isotropic diffusion and quantitative anisotropy. This study identified changes across measures of white and gray matter connectivity, neuroinflammation, and cerebral atrophy that were interrelated and associated with differences in symptoms of PASC. These results provide insights into the long-term cerebral implications of COVID-19.
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Magaki S, Zhang T, Han K, Hilda M, Yong WH, Achim C, Fishbein G, Fishbein MC, Garner O, Salamon N, Williams CK, Valdes-Sueiras MA, Hsu JJ, Kelesidis T, Mathisen GE, Lavretsky H, Singer EJ, Vinters HV. HIV and COVID-19: two pandemics with significant (but different) central nervous system complications. FREE NEUROPATHOLOGY 2024; 5:5-5. [PMID: 38469363 PMCID: PMC10925920 DOI: 10.17879/freeneuropathology-2024-5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Abstract
Human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause significant neurologic disease. Central nervous system (CNS) involvement of HIV has been extensively studied, with well-documented invasion of HIV into the brain in the initial stage of infection, while the acute effects of SARS-CoV-2 in the brain are unclear. Neuropathologic features of active HIV infection in the brain are well characterized whereas neuropathologic findings in acute COVID-19 are largely non-specific. On the other hand, neuropathologic substrates of chronic dysfunction in both infections, as HIV-associated neurocognitive disorders (HAND) and post-COVID conditions (PCC)/long COVID are unknown. Thus far, neuropathologic studies on patients with HAND in the era of combined antiretroviral therapy have been inconclusive, and autopsy studies on patients diagnosed with PCC have yet to be published. Further longitudinal, multidisciplinary studies on patients with HAND and PCC and neuropathologic studies in comparison to controls are warranted to help elucidate the mechanisms of CNS dysfunction in both conditions.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Ting Zhang
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Karam Han
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Mirbaha Hilda
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - William H. Yong
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, CA, USA
| | - Cristian Achim
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Gregory Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Omai Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher K. Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Miguel A. Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey J. Hsu
- Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Glenn E. Mathisen
- Department of Infectious Diseases, Olive View-University of California Los Angeles Medical Center, Sylmar, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elyse J. Singer
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Harry V. Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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40
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León-Moreno LC, Reza-Zaldívar EE, Hernández-Sapiéns MA, Villafaña-Estarrón E, García-Martin M, Ojeda-Hernández DD, Matias-Guiu JA, Gomez-Pinedo U, Matias-Guiu J, Canales-Aguirre AA. Mesenchymal Stem Cell-Based Therapies in the Post-Acute Neurological COVID Syndrome: Current Landscape and Opportunities. Biomolecules 2023; 14:8. [PMID: 38275749 PMCID: PMC10813738 DOI: 10.3390/biom14010008] [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: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
One of the main concerns related to SARS-CoV-2 infection is the symptoms that could be developed by survivors, known as long COVID, a syndrome characterized by persistent symptoms beyond the acute phase of the infection. This syndrome has emerged as a complex and debilitating condition with a diverse range of manifestations affecting multiple organ systems. It is increasingly recognized for affecting the Central Nervous System, in which one of the most prevalent manifestations is cognitive impairment. The search for effective therapeutic interventions has led to growing interest in Mesenchymal Stem Cell (MSC)-based therapies due to their immunomodulatory, anti-inflammatory, and tissue regenerative properties. This review provides a comprehensive analysis of the current understanding and potential applications of MSC-based interventions in the context of post-acute neurological COVID-19 syndrome, exploring the underlying mechanisms by which MSCs exert their effects on neuroinflammation, neuroprotection, and neural tissue repair. Moreover, we discuss the challenges and considerations specific to employing MSC-based therapies, including optimal delivery methods, and functional treatment enhancements.
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Affiliation(s)
- Lilia Carolina León-Moreno
- Unidad de Evaluación Preclínica, Biotecnología Médica Farmacéutica, CONACYT Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Guadalajara 44270, Mexico; (L.C.L.-M.); (M.A.H.-S.); (E.V.-E.)
| | | | - Mercedes Azucena Hernández-Sapiéns
- Unidad de Evaluación Preclínica, Biotecnología Médica Farmacéutica, CONACYT Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Guadalajara 44270, Mexico; (L.C.L.-M.); (M.A.H.-S.); (E.V.-E.)
| | - Erika Villafaña-Estarrón
- Unidad de Evaluación Preclínica, Biotecnología Médica Farmacéutica, CONACYT Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Guadalajara 44270, Mexico; (L.C.L.-M.); (M.A.H.-S.); (E.V.-E.)
| | - Marina García-Martin
- Laboratorio de Neurobiología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.G.-M.); (D.D.O.-H.); (J.A.M.-G.); (U.G.-P.)
| | - Doddy Denise Ojeda-Hernández
- Laboratorio de Neurobiología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.G.-M.); (D.D.O.-H.); (J.A.M.-G.); (U.G.-P.)
| | - Jordi A. Matias-Guiu
- Laboratorio de Neurobiología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.G.-M.); (D.D.O.-H.); (J.A.M.-G.); (U.G.-P.)
| | - Ulises Gomez-Pinedo
- Laboratorio de Neurobiología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.G.-M.); (D.D.O.-H.); (J.A.M.-G.); (U.G.-P.)
| | - Jorge Matias-Guiu
- Departamento de Neurología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Alejandro Arturo Canales-Aguirre
- Unidad de Evaluación Preclínica, Biotecnología Médica Farmacéutica, CONACYT Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Guadalajara 44270, Mexico; (L.C.L.-M.); (M.A.H.-S.); (E.V.-E.)
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Tanashyan M, Morozova S, Raskurazhev A, Kuznetsova P. A prospective randomized, double-blind placebo-controlled study to evaluate the effectiveness of neuroprotective therapy using functional brain MRI in patients with post-covid chronic fatigue syndrome. Biomed Pharmacother 2023; 168:115723. [PMID: 37862966 DOI: 10.1016/j.biopha.2023.115723] [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: 09/01/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND AND PURPOSE to assess executive network using resting-state fMRI and patterns of brain activation using task fMRI with a cognitive paradigm, against the background of taking the drug in comparison with placebo in patients with post-COVID asthenic syndrome. METHODS The study employed a prospective, randomized, double-blind, placebo-controlled trial approach to assess the efficacy of utilizing functional MRI of the brain as a neuroprotective therapy for treating patients with chronic fatigue syndrome following COVID-19. The study included 30 patients matched by sex and age with post-COVID asthenic syndrome. All patients were examined with MFI-20, MoCA, FAS-10 scales, MRI using a Siemens MAGNETOM Prisma 3 T scanner before and after a course of therapy with coordination complex with succinate acid anion (CCSA) or placebo (15 patients each) using resting state fMRI and with cognitive paradigm. RESULTS The changes obtained as a result of the treatment of post-Covid asthenic syndrome demonstrated clinical superiority in the reduction of asthenic symptoms for the group of patients treated with CCSA (MFI-20 scores: -20·0 points in the CCSA group compared to -12 points in the placebo group, p = 0·043). The data obtained also correlate with the analysis of task fMRI and resting state fMRI may indicate an increase in the functional cognitive status after a course of therapy with CCSA. Clinically, this correlates with a statistically significant improvement in the MoCA score (2 points in the CCSA group compared to 1 point in the placebo group, p < 0·05). CONCLUSIONS the study demonstrates the potential effectiveness of CCSA therapy in relation to a wide range of symptoms (chronic fatigue syndrome/ asthenic syndrome and cognitive impairment) in patients with post-COVID syndrome. The first time demonstrated the effectiveness of neuroprotective therapy after post-COVID asthenic syndrome with the use of high-tech neuroimaging techniques.
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Affiliation(s)
- M Tanashyan
- Research Center of Neurology, Moscow, Russia.
| | - S Morozova
- Research Center of Neurology, Moscow, Russia.
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42
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Zhao S, Toniolo S, Hampshire A, Husain M. Effects of COVID-19 on cognition and brain health. Trends Cogn Sci 2023; 27:1053-1067. [PMID: 37657964 PMCID: PMC10789620 DOI: 10.1016/j.tics.2023.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023]
Abstract
COVID-19 is associated with a range of neurological, cognitive, and mental health symptoms both acutely and chronically that can persist for many months after infection in people with long-COVID syndrome. Investigations of cognitive function and neuroimaging have begun to elucidate the nature of some of these symptoms. They reveal that, although cognitive deficits may be related to brain imaging abnormalities in some people, symptoms can also occur in the absence of objective cognitive deficits or neuroimaging changes. Furthermore, cognitive impairment may be detected even in asymptomatic individuals. We consider the evidence regarding symptoms, cognitive deficits, and neuroimaging, as well as their possible underlying mechanisms.
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Affiliation(s)
- Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK.
| | - Sofia Toniolo
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Wellcome Trust Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX2 6AE, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, 926 Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Wellcome Trust Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX2 6AE, UK.
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43
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Du Y, Zhao W, Huang S, Huang C, Li C, Chen Y, Huang Y, Yang L, Li C, Zhang H, Guo H, Liu J. Gray Matter Thickness and Subcortical Nuclear Volume in Men After SARS-CoV-2 Omicron Infection. JAMA Netw Open 2023; 6:e2345626. [PMID: 38032639 PMCID: PMC10690469 DOI: 10.1001/jamanetworkopen.2023.45626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Importance The clinical manifestations and effects on the brain of the SARS-CoV-2 Omicron variant in the acute postinfection phase remain unclear. Objective To investigate the pathophysiological mechanisms underlying clinical symptoms and changes to gray matter and subcortical nuclei among male patients after Omicron infection and to provide an imaging basis for early detection and intervention. Design, Setting, and Participants In this cohort study, a total of 207 men underwent health screening magnetic resonance imaging scans between August 28 and September 18, 2022; among them, 98 provided complete imaging and neuropsychiatric data. Sixty-one participants with Omicron infection were reevaluated after infection (January 6 to 14, 2023). Neuropsychiatric data, clinical symptoms, and magnetic resonance imaging data were collected in the acute post-Omicron period, and their clinical symptoms were followed up after 3 months. Gray matter indexes and subcortical nuclear volumes were analyzed. Associations between changes in gray matter and neuropsychiatric data were evaluated with correlation analyses. Exposures Gray matter thickness and subcortical nuclear volume change data were compared before and after Omicron infection. Main Outcomes and Measures The gray matter indexes and subcutaneous nuclear volume were generated from the 3-dimensional magnetization-prepared rapid acquisition gradient echo and were calculated with imaging software. Results Ninety-eight men underwent complete baseline data collection; of these, 61 (mean [SD] age, 43.1 [9.9] years) voluntarily enrolled in post-Omicron follow-up and 17 (mean [SD] age, 43.5 [10.0] years) voluntarily enrolled in 3-month follow-up. Compared with pre-Omicron measures, Beck Anxiety Inventory scores were significantly increased (median, 4.50 [IQR, 1.00-7.00] to 4.00 [IQR, 2.00-9.75]; P = .006) and depressive distress scores were significantly decreased (median, 18.00 [IQR, 16.00-20.22] to 16.00 [IQR, 15.00-19.00]; P = .003) at the acute post-Omicron follow-up. Fever, headache, fatigue, myalgia, cough, and dyspnea were the main symptoms during the post-Omicron follow-up; among the participants in the 3-month follow-up, fever (11 [64.7%] vs 2 [11.8%]; P = .01), myalgia (10 [58.8%] vs 3 (17.6%]; P = .04), and cough (12 [70.6%] vs 4 [23.5%]; P = .02) were significantly improved. The gray matter thickness in the left precuneus (mean [SD], 2.7 [0.3] to 2.6 [0.2] mm; P < .001) and right lateral occipital region (mean [SD], 2.8 [0.2] to 2.7 [0.2] and 2.5 [0.2] to 2.5 [0.2] mm; P < .001 for both) and the ratio of the right hippocampus volume to the total intracranial volume (mean [SD]. 0.003 [0.0003] to 0.003 [0.0002]; P = .04) were significantly reduced in the post-Omicron follow-up. The febrile group had reduced sulcus depth of the right inferior parietal region compared with the nonfebrile group (mean [SD], 3.9 [2.3] to 4.8 [1.1]; P = .048. In the post-Omicron period, the thickness of the left precuneus was negatively correlated with the Beck Anxiety Inventory scores (r = -0.39; P = .002; false discovery rate P = .02), and the ratio of the right hippocampus to the total intracranial volume was positively correlated with the Word Fluency Test scores (r = 0.34; P = .007). Conclusions and Relevance In this cohort study of male patients infected with the Omicron variant, the duration of symptoms in multiple systems after infection was short. Changes in gray matter thickness and subcortical nuclear volume injury were observed in the post-Omicron period. These findings provide new insights into the emotional and cognitive mechanisms of an Omicron infection, demonstrate its association with alterations to the nervous system, and verify an imaging basis for early detection and intervention of neurological sequelae.
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Affiliation(s)
- Yanyao Du
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center, Hunan Province, Changsha, China
| | - Sihong Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuxin Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Chang Li
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanjing Chen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yijie Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Longtao Yang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Cong Li
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers Ltd, Wuhan, China
| | - Hu Guo
- MR Application, Siemens Healthineers Ltd, Changsha, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center, Hunan Province, Changsha, China
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Basak I, Harfoot R, Palmer JE, Kumar A, Quiñones-Mateu ME, Schweitzer L, Hughes SM. Neuroproteomic Analysis after SARS-CoV-2 Infection Reveals Overrepresented Neurodegeneration Pathways and Disrupted Metabolic Pathways. Biomolecules 2023; 13:1597. [PMID: 38002279 PMCID: PMC10669333 DOI: 10.3390/biom13111597] [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: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Besides respiratory illness, SARS-CoV-2, the causative agent of COVID-19, leads to neurological symptoms. The molecular mechanisms leading to neuropathology after SARS-CoV-2 infection are sparsely explored. SARS-CoV-2 enters human cells via different receptors, including ACE-2, TMPRSS2, and TMEM106B. In this study, we used a human-induced pluripotent stem cell-derived neuronal model, which expresses ACE-2, TMPRSS2, TMEM106B, and other possible SARS-CoV-2 receptors, to evaluate its susceptibility to SARS-CoV-2 infection. The neurons were exposed to SARS-CoV-2, followed by RT-qPCR, immunocytochemistry, and proteomic analyses of the infected neurons. Our findings showed that SARS-CoV-2 infects neurons at a lower rate than other human cells; however, the virus could not replicate or produce infectious virions in this neuronal model. Despite the aborted SARS-CoV-2 replication, the infected neuronal nuclei showed irregular morphology compared to other human cells. Since cytokine storm is a significant effect of SARS-CoV-2 infection in COVID-19 patients, in addition to the direct neuronal infection, the neurons were treated with pre-conditioned media from SARS-CoV-2-infected lung cells, and the neuroproteomic changes were investigated. The limited SARS-CoV-2 infection in the neurons and the neurons treated with the pre-conditioned media showed changes in the neuroproteomic profile, particularly affecting mitochondrial proteins and apoptotic and metabolic pathways, which may lead to the development of neurological complications. The findings from our study uncover a possible mechanism behind SARS-CoV-2-mediated neuropathology that might contribute to the lingering effects of the virus on the human brain.
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Affiliation(s)
- Indranil Basak
- Brain Health Research Centre, Department of Biochemistry, University of Otago, Dunedin 9016, New Zealand
| | - Rhodri Harfoot
- Department of Microbiology and Immunology, University of Otago, Dunedin 9016, New Zealand (M.E.Q.-M.)
| | - Jennifer E. Palmer
- Brain Health Research Centre, Department of Biochemistry, University of Otago, Dunedin 9016, New Zealand
| | - Abhishek Kumar
- Centre for Protein Research, University of Otago, Dunedin 9016, New Zealand
| | - Miguel E. Quiñones-Mateu
- Department of Microbiology and Immunology, University of Otago, Dunedin 9016, New Zealand (M.E.Q.-M.)
| | - Lucia Schweitzer
- Brain Health Research Centre, Department of Biochemistry, University of Otago, Dunedin 9016, New Zealand
| | - Stephanie M. Hughes
- Brain Health Research Centre, Department of Biochemistry, University of Otago, Dunedin 9016, New Zealand
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45
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Delgado-Alonso C, Díez-Cirarda M, Pagán J, Pérez-Izquierdo C, Oliver-Mas S, Fernández-Romero L, Martínez-Petit Á, Valles-Salgado M, Gil-Moreno MJ, Yus M, Matías-Guiu J, Ayala JL, Matias-Guiu JA. Unraveling brain fog in post-COVID syndrome: Relationship between subjective cognitive complaints and cognitive function, fatigue, and neuropsychiatric symptoms. Eur J Neurol 2023. [PMID: 37797297 DOI: 10.1111/ene.16084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE "Brain fog" is a frequent and disabling symptom that can occur after SARS-CoV-2 infection. However, its clinical characteristics and the relationships among brain fog and objective cognitive function, fatigue, and neuropsychiatric symptoms (depression, anxiety) are still unclear. In this study, we aimed to examine the characteristics of brain fog and to understand how fatigue, cognitive performance, and neuropsychiatric symptoms and the mutual relationships among these variables influence subjective cognitive complaints. METHODS A total of 170 patients with cognitive complaints in the context of post-COVID syndrome were evaluated using a comprehensive neuropsychological protocol. The FLEI scale was used to characterize subjective cognitive complaints. Correlation analysis, regression machine-learning algorithms, and mediation analysis were calculated. RESULTS Cognitive complaints were mainly attention and episodic memory symptoms, while executive functions (planning) issues were less often reported. The FLEI scale, a mental ability questionnaire, showed high correlations with a fatigue scale and moderate correlations with the Stroop test, and anxiety and depressive symptoms. Random forest algorithms showed an R2 value of 0.409 for the prediction of FLEI score, with several cognitive tests, fatigue and depression being the best variables used in the prediction. Mediation analysis showed that fatigue was the main mediator between objective and subjective cognition, while the effect of depression was indirect and mediated through fatigue. CONCLUSIONS Brain fog associated with COVID-19 is mainly characterized by attention and episodic memory, and fatigue, which is the main mediator between objective and subjective cognition. Our findings contribute to understanding the pathophysiology of brain fog and emphasize the need to unravel the main mechanisms underlying brain fog, considering several aspects.
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Affiliation(s)
- Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Josué Pagán
- Department of Electronic Engineering, Universidad Politécnica de Madrid, Madrid, Spain
- Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | - Carlos Pérez-Izquierdo
- Department of Agricultural and Forestry Engineering, University Center of Plasencia, University of Extremadura, Plasencia, Spain
| | - Silvia Oliver-Mas
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Lucía Fernández-Romero
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Álvaro Martínez-Petit
- Department of Electronic Engineering, Universidad Politécnica de Madrid, Madrid, Spain
- Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Yus
- Department of Radiology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis Ayala
- Department of Automatic Architecture and Automation, Universidad Complutense, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
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46
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Altmann DM, Whettlock EM, Liu S, Arachchillage DJ, Boyton RJ. The immunology of long COVID. Nat Rev Immunol 2023; 23:618-634. [PMID: 37433988 DOI: 10.1038/s41577-023-00904-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
Long COVID is the patient-coined term for the disease entity whereby persistent symptoms ensue in a significant proportion of those who have had COVID-19, whether asymptomatic, mild or severe. Estimated numbers vary but the assumption is that, of all those who had COVID-19 globally, at least 10% have long COVID. The disease burden spans from mild symptoms to profound disability, the scale making this a huge, new health-care challenge. Long COVID will likely be stratified into several more or less discrete entities with potentially distinct pathogenic pathways. The evolving symptom list is extensive, multi-organ, multisystem and relapsing-remitting, including fatigue, breathlessness, neurocognitive effects and dysautonomia. A range of radiological abnormalities in the olfactory bulb, brain, heart, lung and other sites have been observed in individuals with long COVID. Some body sites indicate the presence of microclots; these and other blood markers of hypercoagulation implicate a likely role of endothelial activation and clotting abnormalities. Diverse auto-antibody (AAB) specificities have been found, as yet without a clear consensus or correlation with symptom clusters. There is support for a role of persistent SARS-CoV-2 reservoirs and/or an effect of Epstein-Barr virus reactivation, and evidence from immune subset changes for broad immune perturbation. Thus, the current picture is one of convergence towards a map of an immunopathogenic aetiology of long COVID, though as yet with insufficient data for a mechanistic synthesis or to fully inform therapeutic pathways.
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Affiliation(s)
- Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK.
| | - Emily M Whettlock
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, UK
| | - Siyi Liu
- Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, UK
| | - Deepa J Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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47
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Limoges MA, Quenum AJI, Chowdhury MMH, Rexhepi F, Namvarpour M, Akbari SA, Rioux-Perreault C, Nandi M, Lucier JF, Lemaire-Paquette S, Premkumar L, Durocher Y, Cantin A, Lévesque S, Dionne IJ, Menendez A, Ilangumaran S, Allard-Chamard H, Piché A, Ramanathan S. SARS-CoV-2 spike antigen-specific B cell and antibody responses in pre-vaccination period COVID-19 convalescent males and females with or without post-covid condition. Front Immunol 2023; 14:1223936. [PMID: 37809081 PMCID: PMC10551145 DOI: 10.3389/fimmu.2023.1223936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Following SARS-CoV-2 infection a significant proportion of convalescent individuals develop the post-COVID condition (PCC) that is characterized by wide spectrum of symptoms encompassing various organs. Even though the underlying pathophysiology of PCC is not known, detection of viral transcripts and antigens in tissues other than lungs raise the possibility that PCC may be a consequence of aberrant immune response to the viral antigens. To test this hypothesis, we evaluated B cell and antibody responses to the SARS-CoV-2 antigens in PCC patients who experienced mild COVID-19 disease during the pre-vaccination period of COVID-19 pandemic. Methods The study subjects included unvaccinated male and female subjects who developed PCC or not (No-PCC) after clearing RT-PCR confirmed mild COVID-19 infection. SARS-CoV-2 D614G and omicron RBD specific B cell subsets in peripheral circulation were assessed by flow cytometry. IgG, IgG3 and IgA antibody titers toward RBD, spike and nucleocapsid antigens in the plasma were evaluated by ELISA. Results The frequency of the B cells specific to D614G-RBD were comparable in convalescent groups with and without PCC in both males and females. Notably, in females with PCC, the anti-D614G RBD specific double negative (IgD-CD27-) B cells showed significant correlation with the number of symptoms at acute of infection. Anti-spike antibody responses were also higher at 3 months post-infection in females who developed PCC, but not in the male PCC group. On the other hand, the male PCC group also showed consistently high anti-RBD IgG responses compared to all other groups. Conclusions The antibody responses to the spike protein, but not the anti-RBD B cell responses diverge between convalescent males and females who develop PCC. Our findings also suggest that sex-related factors may also be involved in the development of PCC via modulating antibody responses to the SARS-CoV-2 antigens.
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Affiliation(s)
- Marc-André Limoges
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | | | | | - Fjolla Rexhepi
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Mozhdeh Namvarpour
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Sara Ali Akbari
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Christine Rioux-Perreault
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Madhuparna Nandi
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Jean-François Lucier
- Department of Biology, Faculty of Science, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Samuel Lemaire-Paquette
- Unité de Recherche Clinique et épidémiologique, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yves Durocher
- Mammalian Cell Expression, Human Health Therapeutics Research Centre, National Research Council Canada, Montreal, QC, Canada
| | - André Cantin
- Departments of Medicine, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Simon Lévesque
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
- Laboratoire de Microbiologie, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
| | - Isabelle J. Dionne
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, Affiliated with CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
| | - Alfredo Menendez
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Subburaj Ilangumaran
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Hugues Allard-Chamard
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alain Piché
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
| | - Sheela Ramanathan
- Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Sherbrooke, QC, Canada
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Jennings S, Corrin T, Waddell L. A systematic review of the evidence on the associations and safety of COVID-19 vaccination and post COVID-19 condition. Epidemiol Infect 2023; 151:e145. [PMID: 37594232 PMCID: PMC10540166 DOI: 10.1017/s0950268823001279] [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: 03/17/2023] [Revised: 06/28/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
Post COVID-19 condition (PCC) refers to persistent or recurring symptoms (>8 weeks) occurring ≤12 weeks following acute COVID-19. The objective of this systematic review was to assess the evidence on the risk of PCC with vaccination before or after COVID-19 or after developing PCC, and the safety of vaccination among those already experiencing PCC. A search was conducted up to 13 December 2022 and standard systematic review methodology was followed. Thirty-one observational studies were included. There is moderate confidence that two doses of vaccine given pre-infection reduced the odds of PCC (pooled OR (pOR) 0.67, 95% CI 0.60-0.74, I2 = 59.9%), but low confidence that one dose may not reduce the odds (pOR 0.64, 95% CI 0.31#x2013;1.31, I2 = 99.2%), and the evidence is very uncertain about the effect of three doses (pOR 0.45, 95% CI 0.10#x2013;1.99, I2 = 30.9%). One of three studies suggested vaccination shortly after COVID-19 may offer additional protection from developing PCC compared to unvaccinated individuals, but this evidence was very uncertain. For those with PCC, vaccination was not associated with worsening PCC symptoms (10 studies) and appears safe (3 studies), but it is unclear if vaccination may change established PCC symptoms.
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Affiliation(s)
- Sydney Jennings
- Public Health Risk Science Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Tricia Corrin
- Public Health Risk Science Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Lisa Waddell
- Public Health Risk Science Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
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49
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López-López L, Calvache-Mateo A, Ortiz-Rubio A, Granados-Santiago M, Heredia-Ciuró A, Martín-Núñez J, Valenza MC. Differences of Disabling Symptoms between Previously Hospitalized or Non-Hospitalized Currently Working Long-COVID Survivors One Year after Infection: A Descriptive Study. Healthcare (Basel) 2023; 11:2306. [PMID: 37628505 PMCID: PMC10454028 DOI: 10.3390/healthcare11162306] [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: 07/21/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to describe the presence of disabling symptoms in currently working Long-COVID survivors by comparing the hospitalized and non-hospitalized one year after infection. Patients with Long-COVID syndrome (LCS) that have been infected by COVID-19 a year ago and were actually working were included. Participants that had been hospitalized due to COVID-19 were included in the LCS hospitalized group, and participants that had not been hospitalized were included in the LCS non-hospitalized group. The eligible patients were prompted to complete the latest self-report version of the COVID-19 Yorkshire Rehabilitation Screening Tool (C19-YRS). A total of 465 subjects were included in the study. Participants in the LCS hospitalized group were significantly older, had a significantly higher BMI, and had a significantly higher prevalence of women compared to the LCS non-hospitalized group. Additionally, participants in the LCS hospitalized group had obtained significantly worse results in symptom severity, functional disability, and global health perceived subscales of C19-YRS compared to the participants included in the LCS non-hospitalized group. We concluded that disabling symptoms are presented in patients with LCS at working age one year after infection and are higher in LCS hospitalized patients compared to LCS non-hospitalized patients.
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Affiliation(s)
- Laura López-López
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
| | - Andrés Calvache-Mateo
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
| | - Araceli Ortiz-Rubio
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
| | | | - Alejandro Heredia-Ciuró
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
| | - Javier Martín-Núñez
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
| | - Marie Carmen Valenza
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.L.-L.); (A.C.-M.); (A.O.-R.); (A.H.-C.); (J.M.-N.); (M.C.V.)
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50
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Díez-Cirarda M, Yus-Fuertes M, Sanchez-Sanchez R, Gonzalez-Rosa JJ, Gonzalez-Escamilla G, Gil-Martínez L, Delgado-Alonso C, Gil-Moreno MJ, Valles-Salgado M, Cano-Cano F, Ojeda-Hernandez D, Gomez-Ruiz N, Oliver-Mas S, Benito-Martín MS, Jorquera M, de la Fuente S, Polidura C, Selma-Calvo B, Arrazola J, Matias-Guiu J, Gomez-Pinedo U, Matias-Guiu JA. Hippocampal subfield abnormalities and biomarkers of pathologic brain changes: from SARS-CoV-2 acute infection to post-COVID syndrome. EBioMedicine 2023; 94:104711. [PMID: 37453364 PMCID: PMC10366393 DOI: 10.1016/j.ebiom.2023.104711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Cognitive deficits are among the main disabling symptoms in COVID-19 patients and post-COVID syndrome (PCS). Within brain regions, the hippocampus, a key region for cognition, has shown vulnerability to SARS-CoV-2 infection. Therefore, in vivo detailed evaluation of hippocampal changes in PCS patients, validated on post-mortem samples of COVID-19 patients at the acute phase, would shed light into the relationship between COVID-19 and cognition. METHODS Hippocampal subfields volume, microstructure, and perfusion were evaluated in 84 PCS patients and compared to 33 controls. Associations with blood biomarkers, including glial fibrillary acidic protein (GFAP), myelin oligodendrocyte glycoprotein (MOG), eotaxin-1 (CCL11) and neurofilament light chain (NfL) were evaluated. Besides, biomarker immunodetection in seven hippocampal necropsies of patients at the acute phase were contrasted against eight controls. FINDINGS In vivo analyses revealed that hippocampal grey matter atrophy is accompanied by altered microstructural integrity, hypoperfusion, and functional connectivity changes in PCS patients. Hippocampal structural and functional alterations were related to cognitive dysfunction, particularly attention and memory. GFAP, MOG, CCL11 and NfL biomarkers revealed alterations in PCS, and showed associations with hippocampal volume changes, in selective hippocampal subfields. Moreover, post mortem histology showed the presence of increased GFAP and CCL11 and reduced MOG concentrations in the hippocampus in post-mortem samples at the acute phase. INTERPRETATION The current results evidenced that PCS patients with cognitive sequalae present brain alterations related to cognitive dysfunction, accompanied by a cascade of pathological alterations in blood biomarkers, indicating axonal damage, astrocyte alterations, neuronal injury, and myelin changes that are already present from the acute phase. FUNDING Nominative Grant FIBHCSC 2020 COVID-19. Department of Health, Community of Madrid. Instituto de Salud Carlos III through the project INT20/00079, co-funded by European Regional Development Fund "A way to make Europe" (JAMG). Instituto de Salud Carlos III (ISCIII) through Sara Borrell postdoctoral fellowship Grant No. CD22/00043) and co-funded by the European Union (MDC). Instituto de Salud Carlos III through a predoctoral contract (FI20/000145) (co-funded by European Regional Development Fund "A way to make Europe") (MVS). Fundación para el Conocimiento Madri+d through the project G63-HEALTHSTARPLUS-HSP4 (JAMG, SOM).
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Affiliation(s)
- Maria Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Miguel Yus-Fuertes
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Javier J Gonzalez-Rosa
- Institute of Research and Biomedical Innovation of Cadiz (INiBICA), Cadiz 11009, Spain; Department of Psychology, University of Cadiz, Cadiz 11003, Spain
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Lidia Gil-Martínez
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Jose Gil-Moreno
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Valles-Salgado
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Fatima Cano-Cano
- Institute of Research and Biomedical Innovation of Cadiz (INiBICA), Cadiz 11009, Spain
| | - Denise Ojeda-Hernandez
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Natividad Gomez-Ruiz
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Silvia Oliver-Mas
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Soledad Benito-Martín
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Manuela Jorquera
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Sarah de la Fuente
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Polidura
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Selma-Calvo
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Arrazola
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Ulises Gomez-Pinedo
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain.
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