Long-term cognitive functioning is impaired in ICU-treated COVID-19 patients: a comprehensive controlled neuropsychological study (original) (raw)
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Cognitive impairment and risk factors in post COVID-19 hospitalized patients
Dementia and Geriatric Cognitive Disorders Extra
Introduction: Numerous reports regarding cognitive deficits after the coronavirus disease 2019 (COVID-19) described as “brain fog” have been published. However, the clinical presentations and risk factors of post COVID-19 cognitive impairment are controversial. This study aimed to assess a) the prevalence of cognitive impairment after COVID-19 hospitalization, b) characteristics of the cognitive deficits, c) risk factors of post COVID-19 cognitive impairment, and d) comparison of cognitive function between post COVID-19 patients and healthy people. Methods: The study comprised 34 SARS-CoV-2 infected patients, admitted to Neurological Institute of Thailand during the peak of COVID-19 pandemic in 2021-2022. These patients came for neuropsychological and clinical evaluations at two weeks follow-up visit. The cognitive impairment and characteristics were measured by TMSE and MoCA. Clinical risk factors and post COVID-19 cognitive impairment were assessed. The comparison of cognitive fun...
Brain, Behavior, & Immunity - Health, 2020
Background: Cognitive manifestations associated with the severity of a novel coronavirus (COVID-19) infection are unknown. An early detection of neuropsychological manifestations could modify the risk of subsequent irreversible impairment and further neurocognitive decline. Methods: In our single-center cohort study, we included all consecutive adult patients, aged between 20 and 60 years old with confirmed COVID-19 infection. Neuropsychological assessment was performed by the same trained neuropsychologist from April, 22nd through June 16th, 2020. Patients with previous known cognitive impairment, any central nervous system or psychiatric disease were excluded. Demographic, clinical, pharmacological and laboratory data were extracted from medical records. Results: Thirty-five patients met inclusion criteria and were included in the study. Patients presenting headache, anosmia, dysgeusia, diarrhea and those who required oxygen therapy had lower scores in memory, attention and executive function subtests as compared to asymptomatic patients. Patients with headache and clinical hypoxia scored lower in the global Cognitive Index (P ¼ 0.002, P ¼ 0.010). A T score lower than 30 was observed in memory domains, attention and semantic fluency (2 [5.7%]) in working memory and mental flexibility (3 [8.6%]) and in phonetic fluency (4 [11.4%]). Higher scores in anxiety and depression (P ¼ 0.047, P ¼ 0.008) were found in patients with cognitive complaints. Conclusions: In our cohort of COVID-19 patients neurologic manifestations were frequent, including cognitive impairment. Neurological symptoms during infection, diarrhea and oxygen therapy were risk factors for neurocognitive impairment. Cognitive complaints were associated with anxiety and depression. * Corresponding author. Hospital Universitari MútuaTerrassa, plaça dels drets humans n 1 (planta-3 despatx. 324),
JAMA Psychiatry, 2022
IMPORTANCE Prolonged neuropsychiatric and cognitive symptoms are increasingly reported in patients after COVID-19, but studies with well-matched controls are lacking. OBJECTIVE To investigate cognitive impairment, neuropsychiatric diagnoses, and symptoms in survivors of COVID-19 compared with patients hospitalized for non-COVID-19 illness. DESIGN, SETTING, AND PARTICIPANTS This prospective case-control study from a tertiary referral hospital in Copenhagen, Denmark, conducted between July 2020 and July 2021, followed up hospitalized COVID-19 survivors and control patients hospitalized for non-COVID-19 illness, matched for age, sex, and intensive care unit (ICU) status 6 months after symptom onset. EXPOSURES Hospitalization for COVID-19. MAIN OUTCOMES AND MEASURES Participants were investigated with the Mini-International Neuropsychiatric Interview, the Montreal Cognitive Assessment (MoCA), neurologic examination, and a semi-structured interview for subjective symptoms. Primary outcomes were total MoCA score and new onset of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric diagnoses. Secondary outcomes included specific psychiatric diagnoses, subjective symptoms, and neurologic examination results. All outcomes were adjusted for age, sex, ICU admission, admission length, and days of follow-up. Secondary outcomes were adjusted for multiple testing. RESULTS A total of 85 COVID-19 survivors (36 [42%] women; mean [SD] age 56.8 [14] years) after hospitalization and 61 matched control patients with non-COVID-19 illness (27 [44%] women, mean age 59.4 years [SD, 13]) were enrolled. Cognitive status measured by total geometric mean MoCA scores at 6-month follow-up was lower (P = .01) among COVID-19 survivors (26.7; 95% CI, 26.2-27.1) than control patients (27.5; 95% CI, 27.0-27.9). The cognitive status improved substantially (P = .004), from 19.2 (95% CI, 15.2-23.2) at discharge to 26.1 (95% CI, 23.1-29.1) for 15 patients with COVID-19 with MoCA evaluations from hospital discharge. A total of 16 of 85 patients with COVID-19 (19%) and 12 of 61 control patients (20%) had a new-onset psychiatric diagnosis at 6-month follow-up, which was not significantly different (odds ratio, 0.93; 95% CI, 0.39-2.27; P = .87). In fully adjusted models, secondary outcomes were not significantly different, except anosmia, which was more common after COVID-19 (odds ratio, 4.56; 95% CI, 1.52-17.42; P = .006); but no longer when adjusting for multiple testing. CONCLUSIONS AND RELEVANCE In this prospective case-control study, cognitive status at 6 months was worse among survivors of COVID-19, but the overall burden of neuropsychiatric and neurologic signs and symptoms among survivors of COVID-19 requiring hospitalization was comparable with the burden observed among matched survivors hospitalized for non-COVID-19 causes.
Prolonged cognitive deficits after COVID-19
Journal of the Neurological Sciences, 2021
Background and aims Cognitive deficits are a common complication of COVID-19. Multiple factors associated with the illness and its treatment may contribute to cognitive deficits. In this study, we analysed neuropsychological data from a cohort of patients recovering from COVID-19 hospitalization who required different types of oxygen/ ventilation therapy. Methods We recruited 77 (aged 22-77 years; 57 males) patients hospitalized for complications of SARS-CoV-2 infection in different
Cognitive impact on patients with COVID-19 infection
The Egyptian Journal of Bronchology
Background SARS‐COV‐2 infection reframed medical knowledge in many aspects, yet there is still a lot to be discovered. Coronavirus disease 19 (COVID-19) can cause neuropsychiatric, psychological, and psychosocial impairments. Literature regarding the cognitive impact of COVID-19 is still limited. This study aims to evaluate cognitive function, anxiety, and depression among patients with coronavirus disease 19. Methods Sixty COVID-19 patients were recruited and sub-grouped according to the site of care into three groups, home isolation, ward, and RICU, and compared with 60 matched control participants. Entire clinical history, O2 saturation, mini-mental state examination (MMSE), Hamilton’s anxiety (HAM-A), and depression rating scales (HAM-D) were assessed. Results MMSE showed significantly lowest results for the ICU group, with a value of 21.65 ± 3.52. Anxiety levels were the highest for the ICU group, with a highly significant difference vs. the home isolation group (42.45 ± 4.85 v...
One‐year cognitive follow‐up of COVID‐19 hospitalized patients
European Journal of Neurology, 2022
Background and purposeCognitive dysfunction has been observed following recovery from COVID‐19. To the best of our knowledge, however, no study has assessed the progression of cognitive impairment after 1 year. The aim was to assess cognitive functioning at 1 year from hospital discharge, and eventual associations with specific clinical variables.MethodsSeventy‐six patients (aged 22–74 years) who had been hospitalized for COVID‐19 were recruited. Patients received neuropsychological assessments at 5 (n = 76) and 12 months (n = 53) from hospital discharge.ResultsOver half (63.2%) of the patients had deficits in at least one test at 5 months. Compared to the assessment at 5 months, verbal memory, attention and processing speed improved significantly after 1 year (all p < 0.05), whereas visuospatial memory did not (all p > 0.500). The most affected domains after 1 year were processing speed (28.3%) and long‐term visuospatial (18.1%) and verbal (15.1%) memory. Lower PaO2/FiO2 rati...
Clinical features and cognitive sequelae in COVID-19: a retrospective study on N=152 patients
Neurological Sciences
Background The novel human coronavirus (SARS-CoV-2) shows neurotropism and systemically affects the central nervous system (CNS). Cognitive deficits have been indeed reported as both short-and long-term sequelae of SARS-CoV-2 infection. However, the association between these disturbances and background/disease-related clinical features remains elusive. This work aimed at exploring how post-infective cognitive status relates to clinical/treatment outcomes by controlling for premorbid/current risk factors for cognitive deficits. Methods Cognitive measures (Mini-Mental State Examination, MMSE) of N=152 COVID-19 patient were retrospectively assessed in relation to disease severity, intensive care unit (ICU) admission, steroidal treatment, and occurrence of other viral/bacterial infections by controlling for remote/recent/COVID-19-related risk factors for cognitive deficits (at-risk vs. not-at-risk: Neuro+ vs. Neuro−). Results Descriptively, impaired MMSE performances were highly prevalent in mild-to-moderate patients (26.3%). ICUadmitted patients made more errors (p=.021) on the MMSE than those not admitted when partialling out risk factors and age-the latter negatively influencing performances. When addressing Neuro− patients only, steroidal treatment appears to improve MMSE scores among those suffering from other infections (p=.025). Discussion Cognitive sequelae of COVID-19 are likely to arise from a complex interplay between background/clinical premorbid features and disease-related/interventional procedures and outcomes. Mild-to-moderate patients requiring assistive ventilation who however are not admitted to an ICU are more likely to suffer from cognitive deficits-despite their etiology remaining elusive.
Persistent COVID-19-associated neurocognitive symptoms in non-hospitalized patients
Journal of NeuroVirology, 2021
As cases of coronavirus disease 2019 (COVID-19) mount worldwide, attention is needed on potential long-term neurologic impacts for the majority of patients who experience mild to moderate illness managed as outpatients. To date, there has not been discussion of persistent neurocognitive deficits in patients with milder COVID-19. We present two cases of non-hospitalized patients recovering from COVID-19 with persistent neurocognitive symptoms. Commonly used cognitive screens were normal, while more detailed testing revealed working memory and executive functioning deficits. An observational cohort study of individuals recovering from COVID-19 (14 or more days following symptom onset) identified that among the first 100 individuals enrolled, 14 were non-hospitalized patients reporting persistent cognitive issues. These 14 participants had a median age of 39 years (interquartile range: 35–56), and cognitive symptoms were present for at least a median of 98 days (interquartile range: 71...
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in coronavirus disease 2019 (COVID-19), has caused a pandemic. There is now considerable evidence that neuropsychological functions could be affected. We further tested this hypothesis on a sample of post COVID-19 patients, who, initially, had been severely affected.METHODS: We tested 22 post COVID-19 patients who, after the intensive care unit, were submitted to our rehabilitation unit to be treated for severe post COVID-19 sequelae. All patients were assessed with a comprehensive neuropsychological battery including measures assessing perceptual, attentive, mnestic, linguistic, and executive functions, and overall cognitive status. The patients were also administered rehabilitation measures including scales for investigating aerobic capacity/endurance deficits, dyspnea, and fatigue. RESULTS: Our findings revealed that evidence of neuropsychological disorders on post COVID-19 patients was very limit...
Long-Lasting Cognitive Abnormalities after COVID-19
Brain Sciences
Considering the mechanisms capable of causing brain alterations in COVID-19, we aimed to study the occurrence of cognitive abnormalities in the months following hospital discharge. We recruited 38 (aged 22–74 years; 27 males) patients hospitalized for complications of SARS-CoV-2 infection in nonintensive COVID units. Participants underwent neuropsychological testing about 5 months after hospital discharge. Of all patients, 42.1% had processing speed deficits, while 26.3% showed delayed verbal recall deficits. Twenty-one percent presented with deficits in both processing speed and verbal memory. Bivariate analysis revealed a positive correlation between the lowest arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2) (P/F) ratio during hospitalization and verbal memory consolidation performance (SRT-LTS score, r = 0.404, p = 0.027), as well as a positive correlation between SpO2 levels upon hospital arrival and delayed verbal recall performance (SRT-D score, rs...