Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status

Abstract

Background. Cognitive impairment has been reported in the aftermath of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection. We investigated the possible association between cognitive impairment and the main clinical and functional status variables in a cohort of convalescent COVID-19 patients without premorbid diseases potentially affecting cognition. Methods. We consecutively screened for inclusion of convalescent COVID-19 patients referring to a post-acute care facility for pulmonary rehabilitation. All the enrolled patients were assessed for cognitive functions. We also investigated features of psychological distress (anxiety, depression, symptoms of posttraumatic stress disorder and quality of life) and cardiac and pulmonary functional status. Results. The 63 enrolled patients (mean age 59.82 ± 10.78, male gender = 47) showed a high frequency of depressive symptoms (76.2%) and anxiety (55.5%), and a high prevalence of symptoms of posttraumatic stress disorder (PTSD, 44.4%). About half of the total sample showed reduced cognitive efficiency (RCE, 44.4%) in the domains of spatial and verbal long-term memory and executive functions. Patients with RCE more frequently showed alteration of blood pressure (BP) circadian rhythm (p = 0.01), higher levels of D-Dimer (p = 0.03), had experienced a severe illness (p = 0.02), had longer disease duration (p = 0.04), more clinically relevant symptoms of PTSD (p = 0.02), more frequent cognitive complaints (p = 0.002), higher anxiety scores (p = 0.01) and lower quality of life (p = 0.02) than patients with normal cognitive efficiency. Conclusions. Our findings indicated a possible association between the RCE after COVID-19 and some cardiological variables, including some indirect measures of a residual autonomic disorder, such as the presence of an altered BP circadian rhythm. Future research studies with large samples are needed to provide valid conclusions.

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“…As the presence of depression is linked to cognitive impairments, and a higher frequency of cognitive symptoms not always confirmed by the objective assessment ( 30 ), a subanalysis was conducted, excluding patients with depression.…”

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“…We found that depression is widespread in patients have survived COVID-19, especially in women, and often co-exists with fatigue, dyspnea, and cognitive dysfunction, affecting patients’ quality of life [62, 63]. Therefore, psychological support and psychiatric intervention should be considered during the process of cardiac rehabilitation (Fig.…”

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“…Кроме того, пациенты с RCE имели значительно более высокие показатели тревожности, а также, как правило, демонстрировали более низкие показатели по опроснику EuroQol-5D (EQ-5D, Европейский опросник оценки качества жизни). Обращает внимание, что пациенты группы RCE чаще демонстрировали изменение циркадного ритма артериального давления (АД) (non-dipper), что подтверждает связь между когнитивными нарушениями и изменением циркадного ритма АД [29].…”

“…Учитывая, что артериальная гипертензия является наиболее часто встречающейся патологией в структуре коморбидности НКВИ и имеет взаимосвязи с когнитивным статусом, нестабильное АД может играть важную роль в развитии когнитивных нарушений после COVID-19 [29].…”