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Austin TA, Thomas ML, Lu M, Hodges CB, Darowski ES, Bergmans R, Parr S, Pickell D, Catazaro M, Lantrip C, Twamley EW. Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection. Neuropsychol Rev 2024:10.1007/s11065-024-09642-6. [PMID: 38862725 DOI: 10.1007/s11065-024-09642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.
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Affiliation(s)
- Tara A Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA.
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Colorado Springs, Fort Collins, USA
| | - Min Lu
- University of Miami, Miami, FL, USA
| | - Cooper B Hodges
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | | | - Rachel Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Parr
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Delaney Pickell
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
| | - Mikayla Catazaro
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Crystal Lantrip
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Réus GZ, Recco KCC, Machado KMSH, Silva RH, Arent CO, Amboni G, Niero FS, Pedro LC, Borba LA, Bagatini MD, de Oliveira GG, da Silva AP, Mingoti MED, Ignácio ZM, Gava FF, Petronilho F, Quevedo J, Ceretta LB, de Azevedo Cardoso T. COVID-19, Anxiety, and Body Mass Index Increase Leptin Levels: a Cross-sectional Multicentric Study. Mol Neurobiol 2023:10.1007/s12035-023-03788-9. [PMID: 38123701 DOI: 10.1007/s12035-023-03788-9] [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: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
Although many efforts have been made to understand the pathophysiological mechanisms of COVID-19, critical gaps remain to be explored. This study aimed to investigate potential alterations in adipokine levels (specifically adiponectin, leptin, and resistin) among individuals with COVID-19. Within this population, we further assessed the association between these markers with both, body mass index (BMI) and psychiatric symptoms. This cross-sectional study included an age- and sex-matched sample of adults with COVID-19 (cases) and without COVID-19 (controls). We evaluated the severity of psychiatric symptoms, BMI, and adipokines. Individuals with COVID-19 presented greater BMI, stress levels, and leptin levels when compared to controls. Leptin levels were greater in individuals with moderate/severe COVID-19 as compared to individuals with COVID-19 who were asymptomatic or having mild symptoms. Leptin levels were positively correlated with BMI, severity of depressive and anxiety symptoms, and stress levels in the total sample. Leptin levels were also positively correlated with BMI, severity of anxiety symptoms, and stress levels in controls. In cases, there was a positive correlation between adiponectin and the severity of depressive symptoms and stress levels and leptin/resistin with BMI. A linear regression model revealed that BMI, severity of anxiety symptoms, and the diagnosis of COVID-19 are independently associated with increased leptin levels. Thus, leptin levels seem to be impacted by the COVID-19 infection, anxiety, and BMI.
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Affiliation(s)
- Gislaine Z Réus
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil.
| | - Kelen C C Recco
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Karynne M S H Machado
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Ritele H Silva
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Camila O Arent
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Graziela Amboni
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Flávia S Niero
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Lucas C Pedro
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Laura A Borba
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
| | - Margarete D Bagatini
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Chapecó, SC, Brazil
| | - Gabriela G de Oliveira
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Chapecó, SC, Brazil
| | - Alana Patrícia da Silva
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Chapecó, SC, Brazil
| | - Maiqueli Eduarda D Mingoti
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Chapecó, SC, Brazil
| | - Zuleide Maria Ignácio
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Chapecó, SC, Brazil
| | - Fernanda F Gava
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil
| | - Fabricia Petronilho
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil
| | - João Quevedo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, 88806-000, Brazil
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Luciane B Ceretta
- Graduate Program in Public Health, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
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Shi W, Jiang D, Rando H, Khanduja S, Lin Z, Hazel K, Pottanat G, Jones E, Xu C, Lin D, Yasar S, Cho SM, Lu H. Blood-brain barrier breakdown in COVID-19 ICU survivors: an MRI pilot study. NEUROIMMUNE PHARMACOLOGY AND THERAPEUTICS 2023; 2:333-338. [PMID: 38058998 PMCID: PMC10696574 DOI: 10.1515/nipt-2023-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
Objectives Coronavirus disease 2019 (COVID-19) results in severe inflammation at the acute stage. Chronic neuroinflammation and abnormal immunological response have been suggested to be the contributors to neuro-long-COVID, but direct evidence has been scarce. This study aims to determine the integrity of the blood-brain barrier (BBB) in COVID-19 intensive care unit (ICU) survivors using a novel MRI technique. Methods COVID-19 ICU survivors (n=7) and age and sex-matched control participants (n=17) were recruited from June 2021 to March 2023. None of the control participants were hospitalized due to COVID-19 infection. The COVID-19 ICU survivors were studied at 98.6 ± 14.9 days after their discharge from ICU. A non-invasive MRI technique was used to assess the BBB permeability to water molecules, in terms of permeability surface area-product (PS) in the units of mL/100 g/min. Results PS was significantly higher in COVID-19 ICU survivors (p=0.038) when compared to the controls, with values of 153.1 ± 20.9 mL/100 g/min and 132.5 ± 20.7 mL/100 g/min, respectively. In contrast, there were no significant differences in whole-brain cerebral blood flow (p=0.649) or brain volume (p=0.471) between the groups. Conclusions There is preliminary evidence of a chronic BBB breakdown in COVID-19 survivors who had a severe acute infection, suggesting a plausible contributor to neurological long-COVID symptoms.
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Affiliation(s)
- Wen Shi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah Rando
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivalika Khanduja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ebony Jones
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Min Cho
- Department of Neurology, Neurosurgery, Surgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
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Chang L, Ryan MC, Liang H, Zhang X, Cunningham E, Wang J, Wilson E, Herskovits EH, Kottilil S, Ernst TM. Changes in Brain Activation Patterns During Working Memory Tasks in People With Post-COVID Condition and Persistent Neuropsychiatric Symptoms. Neurology 2023; 100:e2409-e2423. [PMID: 37185175 PMCID: PMC10256123 DOI: 10.1212/wnl.0000000000207309] [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: 11/21/2022] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Post-COVID condition (PCC) is common and often involves neuropsychiatric symptoms. This study aimed to use blood oxygenation level-dependent fMRI (BOLD-fMRI) to assess whether participants with PCC had abnormal brain activation during working memory (WM) and whether the abnormal brain activation could predict cognitive performance, motor function, or psychiatric symptoms. METHODS The participants with PCC had documented coronavirus disease 2019 (COVID-19) at least 6 weeks before enrollment. Healthy control participants had no prior history of COVID-19 and negative tests for severe acute respiratory syndrome coronavirus 2. Participants were assessed using 3 NIH Toolbox (NIHTB) batteries for Cognition (NIHTB-CB), Emotion (NIHTB-EB), and Motor function (NIHTB-MB) and selected tests from the Patient-Reported Outcomes Measurement Information System (PROMIS). Each had BOLD-fMRI at 3T, during WM (N-back) tasks with increasing attentional/WM load. RESULTS One hundred sixty-nine participants were screened; 50 fulfilled the study criteria and had complete and usable data sets for this cross-sectional cohort study. Twenty-nine participants with PCC were diagnosed with COVID-19 242 ± 156 days earlier; they had similar ages (42 ± 12 vs 41 ± 12 years), gender proportion (65% vs 57%), racial/ethnic distribution, handedness, education, and socioeconomic status, as the 21 uninfected healthy controls. Despite the high prevalence of memory (79%) and concentration (93%) complaints, the PCC group had similar performance on the NIHTB-CB as the controls. However, participants with PCC had greater brain activation than the controls across the network (false discovery rate-corrected p = 0.003, Tmax = 4.17), with greater activation in the right superior frontal gyrus (p = 0.009, Cohen d = 0.81, 95% CI 0.15-1.46) but lesser deactivation in the default mode regions (p = 0.001, d = 1.03, 95% CI 0.61-1.99). Compared with controls, participants with PCC also had poorer dexterity and endurance on the NIHTB-MB, higher T scores for negative affect and perceived stress, but lower T scores for psychological well-being on the NIHTB-EB, as well as more pain symptoms and poorer mental and physical health on measures from the PROMIS. Greater brain activation predicted poorer scores on measures that were abnormal on the NIHTB-EB. DISCUSSION Participants with PCC and neuropsychiatric symptoms demonstrated compensatory neural processes with greater usage of alternate brain regions, and reorganized networks, to maintain normal performance during WM tasks. BOLD-fMRI was sensitive for detecting brain abnormalities that correlated with various quantitative neuropsychiatric symptoms.
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Affiliation(s)
- Linda Chang
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore.
| | - Meghann C Ryan
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Huajun Liang
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Xin Zhang
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Eric Cunningham
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Justin Wang
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Eleanor Wilson
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Edward H Herskovits
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Shyamasundaran Kottilil
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Thomas M Ernst
- From the Diagnostic Radiology and Nuclear Medicine (L.C., M.C.R., H.L., X.Z., E.C., J.W., E.H.H., T.M.E.), and Department of Neurology (L.C.), University of Maryland School of Medicine; Department of Neurology (L.C., T.M.E.), Johns Hopkins University School of Medicine, Baltimore; Program in Neuroscience (L.C., M.C.R.), Institute of Human Virology (L.C., E.W., S.K.), and Division of Infectious Disease (E.W., S.K.), Department of Medicine, University of Maryland School of Medicine, Baltimore
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