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Miskowiak KW, Fugledalen L, Jespersen AE, Sattler SM, Podlekareva D, Rungby J, Porsberg CM, Johnsen S. Trajectory of cognitive impairments over 1 year after COVID-19 hospitalisation: Pattern, severity, and functional implications. Eur Neuropsychopharmacol 2022; 59:82-92. [PMID: 35561540 PMCID: PMC9008126 DOI: 10.1016/j.euroneuro.2022.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023]
Abstract
The ongoing Coronavirus Disease (COVID-19) pandemic has so far affected more than 500 million people. Lingering fatigue and cognitive difficulties are key concerns because they impede productivity and quality of life. However, the prevalence and duration of neurocognitive sequelae and association with functional outcomes after COVID-19 are unclear. This longitudinal study explored the frequency, severity and pattern of cognitive impairment and functional implications 1 year after hospitalisation with COVID-19 and its trajectory from 3 months after hospitalisation. Patients who had been hospitalised with COVID-19 from our previously published 3-months study at the Copenhagen University Hospital were re-invited for a 1-year follow-up assessment of cognitive function, functioning and depression symptoms. Twenty-five of the 29 previously assessed patients (86%) were re-assessed after 1 year (11±2 months). Clinically significant cognitive impairments were identified in 48-56 % of patients depending on the cut-off, with verbal learning and executive function being most severely affected. This was comparable to the frequency of impairments observed after 3 months. Objectively measured cognitive impairments scaled with subjective cognitive difficulties, reduced work capacity and poorer quality of life. Further, cognitive impairments after 3 months were associated with the severity of subsequent depressive symptoms after 1 year. In conclusion, the stable cognitive impairments in approximately half of patients hospitalized with COVID-19 and negative implications for work functioning, quality of life and mood symptoms underline the importance of screening for and addressing cognitive sequelae after severe COVID-19.
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Affiliation(s)
- K W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
| | - L Fugledalen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - A E Jespersen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - S M Sattler
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark
| | - D Podlekareva
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark
| | - J Rungby
- Department of Endocrinology, Bispebjerg University Hospital, Denmark and Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
| | - C M Porsberg
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark
| | - S Johnsen
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen; Denmark
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Miskowiak KW, Johnsen S, Sattler SM, Nielsen S, Kunalan K, Rungby J, Lapperre T, Porsberg CM. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. Eur Neuropsychopharmacol 2021; 46:39-48. [PMID: 33823427 PMCID: PMC8006192 DOI: 10.1016/j.euroneuro.2021.03.019] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has affected more than 100 million people and clinics are being established for diagnosing and treating lingering symptoms, so called long-COVID. A key concern are neurological and long-term cognitive complications. At the same time, the prevalence and nature of the cognitive sequalae of COVID-19 are unclear. The present study aimed to investigate the frequency, pattern and severity of cognitive impairments 3-4 months after COVID-19 hospital discharge, their relation to subjective cognitive complaints, quality of life and illness variables. We recruited patients at their follow-up visit at the respiratory outpatient clinic, Copenhagen University Hospital, Bispebjerg, approximately four months after hospitalisation with COVID-19. Patients underwent pulmonary, functional and cognitive assessments. Twenty-nine patients were included. The percentage of patients with clinically significant cognitive impairment ranged from 59% to 65% depending on the applied cut-off for clinical relevance of cognitive impairment, with verbal learning and executive functions being most affected. Objective cognitive impairment scaled with subjective cognitive complaints, lower work function and poorer quality of life. Cognitive impairments were associated with d-dimer levels during acute illness and residual pulmonary dysfunction. In conclusion, these findings provide new evidence for frequent cognitive sequelae of COVID-19 and indicate an association with the severity of the lung affection and potentially restricted cerebral oxygen delivery. Further, the associations with quality of life and functioning call for systematic cognitive screening of patients after recovery from severe COVID-19 illness and implementation of targeted treatments for patients with persistent cognitive impairments.
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Affiliation(s)
- K W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; NEAD Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - S Johnsen
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - S M Sattler
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - S Nielsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; NEAD Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - K Kunalan
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - J Rungby
- Department of Endocrinology, Bispebjerg University Hospital, Denmark; Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
| | - T Lapperre
- Department of Pulmonology, University Hospital Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - C M Porsberg
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
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