Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting

Abstract

The coronavirus disease 19 (COVID-19) can cause neurological, psychiatric, psychological, and psychosocial impairments. Literature regarding cognitive impact of COVID-19 is still limited. The aim of this study was to evaluate cognitive deficits and emotional distress among COVID-19 and post–COVID-19 patients who required functional rehabilitation. Specifically, this study explored and compared cognitive and psychological status of patients in the subacute phase of the disease (COVID-19 group) and patients in the postillness period (post–COVID-19 group). Forty patients admitted to rehabilitation units were enrolled in the study and divided into two groups according to the phase of the disease: (a) COVID-19 group (n = 20) and (b) post–COVID-19 group (n = 20). All patients underwent a neuropsychological assessment including Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Impact of Event Scale–Revised (IES-R). A larger part of the COVID group showed neuropsychological deficits in the total MMSE (35%) compared to the post-COVID group (5%), whereas the majority of both groups (75–70%) reported cognitive impairments in the total MoCA. The post-COVID group reported significantly higher score in MMSE subtests of language (p = 0.02) and in MoCA subtests of executive functions (p = 0.05), language (p = 0.01), and abstraction (p = 0.02) compared to the COVID group. Regarding emotional disturbances, ~40% of patients presented with mild to moderate depression (57.9–60%). The post–COVID-19 group reported significantly higher levels of distress at the IES-R compared to the COVID group (p = 0.02). These findings highlight the gravity of neuropsychological and psychological symptoms that can be induced by COVID-19 infection and the need for tailored rehabilitation, including cognitive training and psychological support.

Screening for cognitive sequelae of SARS-CoV-2 infection: a comparison between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA)

“…However, the MoCA proved to be slightly more sensitive than the MMSE in detecting sub-clinical cognitive changes, as well as abler than the MMSE in differentiating between diverse levels of cognitive efficiency [ 4 ]. These findings are in line with previous ones on the MoCA—which were also paralleled by neurofunctional evidence [ 4 , 9 ].…”

“…However, the MoCA proved to be slightly more sensitive than the MMSE in detecting sub-clinical cognitive changes, as well as abler than the MMSE in differentiating between diverse levels of cognitive efficiency [ 4 ]. These findings are in line with previous ones on the MoCA—which were also paralleled by neurofunctional evidence [ 4 , 9 ]. Such differential performances of the two screeners appear to be also supported by the fact that, when considering different ability levels, their agreement was higher for patients whose putative cognitive impairment could be more easily detected (RCD+).…”

“…Among screening tools, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) have proved effective in detecting global cognition deficits following COVID-19 [ 2 ]—despite the former and the latter seemingly being more sensitive to severe and mild-to-moderate dysfunctions, respectively [ 4 ]. In this respect, the choice of suitable screeners is further challenged by the complex interplay between disease-related outcomes—i.e., encephalopathic complications of COVID-19 and iatrogenic effects of COVID-19 treatments on the brain—and premorbid neurological/medical-general risk factors for cognitive impairment [ 4 ].…”

Can SARS-CoV-2 Infection Lead to Neurodegeneration and Parkinson’s Disease?

“…Cognitive decline was not only observed during acute infection, but there are also reports of persistent cognitive impairment after recovering from COVID-19, as MOCA abnormalities were detected in a group of post-COVID-19 patients [ 116 ]. Another study confirmed that cognitive deficits persisted in 70% of COVID-19 patients for at least 1 month after hospital discharge [ 116 , 117 ]. Similarly, 46 of 57 recovering COVID-19 patients (81%) had signs of cognitive impairment [ 13 , 118 ].…”

Cognitive symptoms after COVID-19

“…( 35 ) The most frequent profile of post–COVID-19 cognitive impairment involves executive function and may be detected from 4 weeks after diagnosis (subacute or convalescent phase) and even after 12 weeks (persistent symptomatology). ( 36 ) Most published studies use cognitive screening tests (eg, the MoCA or Mini–Mental State Examination), administered either in person ( 37. , 38.…”