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Clark P, Rosenberg P, Oh ES, Parker A, Vannorsdall T, Azola A, Nickles E, Galiatsatos P, Malik M. Methylphenidate for the Treatment of Post-COVID Cognitive Dysfunction (Brain Fog). J Med Cases 2024; 15:195-200. [PMID: 39091579 PMCID: PMC11287906 DOI: 10.14740/jmc4254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
A substantial number of patients develop cognitive dysfunction after contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), significantly contributing to long-coronavirus disease (COVID) morbidity. Despite the urgent and overwhelming clinical need, there are currently no proven interventions to treat post-COVID cognitive dysfunction (PCCD). Psychostimulants like methylphenidate may enhance both noradrenergic and dopaminergic pathways in mesolimbic and pre-frontal areas, thus improving memory and cognition. We present a case series of six patients who were treated at the Johns Hopkins Post-Acute COVID-19 Team (PACT) clinic for PCCD with methylphenidate 5 - 20 mg in the context of routine clinical care and followed for 4 to 8 weeks. Baseline and post-treatment outcomes included subjective cognitive dysfunction and objective performance on a battery devised to measure cognitive dysfunction in long-COVID patients. Three out of the six patients reported subjective improvement with methylphenidate, one patient described it as "notable" and another as "marked" improvement in memory and concentration. We also found significant pre-treatment subjective complaints of cognitive dysfunction; however, formal cognitive assessment scores were not severely impaired. A statistically significant difference in pre and post scores, favoring intervention, was found for the following cognitive assessments: Hopkins verbal learning test (HVLT) immediate recall, HVLT delayed recall and category-cued verbal fluency. The current series demonstrates promising neurocognitive effects of methylphenidate for long-COVID cognitive impairment, particularly in recall and verbal fluency domains.
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Affiliation(s)
- Phoebe Clark
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther S. Oh
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Parker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy Vannorsdall
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Nickles
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mansoor Malik
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Khodanovich M, Naumova A, Kamaeva D, Obukhovskaya V, Vasilieva S, Schastnyy E, Kataeva N, Levina A, Kudabaeva M, Pashkevich V, Moshkina M, Tumentceva Y, Svetlik M. Neurocognitive Changes in Patients with Post-COVID Depression. J Clin Med 2024; 13:1442. [PMID: 38592295 PMCID: PMC10933987 DOI: 10.3390/jcm13051442] [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: 12/16/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Depression and cognitive impairment are recognized complications of COVID-19. This study aimed to assess cognitive performance in clinically diagnosed post-COVID depression (PCD, n = 25) patients using neuropsychological testing. Methods: The study involved 71 post-COVID patients with matched control groups: recovered COVID-19 individuals without complications (n = 18) and individuals without prior COVID-19 history (n = 19). A post-COVID depression group (PCD, n = 25) was identified based on psychiatric diagnosis, and a comparison group (noPCD, n = 46) included participants with neurological COVID-19 complications, excluding clinical depression. Results: The PCD patients showed gender-dependent significant cognitive impairment in the MoCA, Word Memory Test (WMT), Stroop task (SCWT), and Trail Making Test (TMT) compared to the controls and noPCD patients. Men with PCD showed worse performances on the SCWT, in MoCA attention score, and on the WMT (immediate and delayed word recall), while women with PCD showed a decline in MoCA total score, an increased processing time with less errors on the TMT, and worse immediate recall. No differences between groups in Sniffin's stick test were found. Conclusions: COVID-related direct (post-COVID symptoms) and depression-mediated (depression itself, male sex, and severity of COVID-19) predictors of decline in memory and information processing speed were identified. Our findings may help to personalize the treatment of depression, taking a patient's gender and severity of previous COVID-19 disease into account.
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Affiliation(s)
- Marina Khodanovich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Anna Naumova
- Department of Radiology, School of Medicine, South Lake Union Campus, University of Washington, 850 Republican Street, Seattle, WA 98109, USA;
| | - Daria Kamaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Laboratory of Molecular Genetics and Biochemistry, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia
| | - Victoria Obukhovskaya
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Department of Fundamental Psychology and Behavioral Medicine, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 6340505, Russia
| | - Svetlana Vasilieva
- Department of Affective States, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia; (S.V.); (E.S.)
| | - Evgeny Schastnyy
- Department of Affective States, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia; (S.V.); (E.S.)
| | - Nadezhda Kataeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Department of Neurology and Neurosurgery, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 6340505, Russia
| | - Anastasia Levina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Medica Diagnostic and Treatment Center, 86 Sovetskaya Street, Tomsk 634510, Russia
| | - Marina Kudabaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Valentina Pashkevich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Marina Moshkina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Yana Tumentceva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Mikhail Svetlik
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
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Marinkovic K, White DR, Alderson Myers A, Parker KS, Arienzo D, Mason GF. Cortical GABA Levels Are Reduced in Post-Acute COVID-19 Syndrome. Brain Sci 2023; 13:1666. [PMID: 38137114 PMCID: PMC10741691 DOI: 10.3390/brainsci13121666] [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: 11/11/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
After recovering from the acute COVID-19 illness, a substantial proportion of people continue experiencing post-acute sequelae of COVID-19 (PASC), also termed "long COVID". Their quality of life is adversely impacted by persistent cognitive dysfunction and affective distress, but the underlying neural mechanisms are poorly understood. The present study recruited a group of mostly young, previously healthy adults (24.4 ± 5.2 years of age) who experienced PASC for almost 6 months following a mild acute COVID-19 illness. Confirming prior evidence, they reported noticeable memory and attention deficits, brain fog, depression/anxiety, fatigue, and other symptoms potentially suggestive of excitation/inhibition imbalance. Proton magnetic resonance spectroscopy (1H-MRS) was used to examine the neurochemical aspects of cell signaling with an emphasis on GABA levels in the occipital cortex. The PASC participants were compared to a control (CNT) group matched in demographics, intelligence, and an array of other variables. Controlling for tissue composition, biological sex, and alcohol intake, the PASC group had lower GABA+/water than CNT, which correlated with depression and poor sleep quality. The mediation analysis revealed that the impact of PASC on depression was partly mediated by lower GABA+/water, indicative of cortical hyperexcitability as an underlying mechanism. In addition, N-acetylaspartate (NAA) tended to be lower in the PASC group, possibly suggesting compromised neuronal integrity. Persistent neuroinflammation may contribute to the pathogenesis of PASC-related neurocognitive dysfunction.
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Affiliation(s)
- Ksenija Marinkovic
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - David R. White
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
| | - Austin Alderson Myers
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Katie S. Parker
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
| | - Donatello Arienzo
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - Graeme F. Mason
- Department of Radiology and Biomedical Imaging, Psychiatry, and Biomedical Engineering, Yale University, New Haven, CT 06520, USA;
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