COVCOG 1: Factors Predicting Physical, Neurological and Cognitive Symptoms in Long COVID in a Community Sample. A First Publication From the COVID and Cognition Study

Abstract

Since its first emergence in December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into a global pandemic. Whilst often considered a respiratory disease, a large proportion of COVID-19 patients report neurological symptoms, and there is accumulating evidence for neural damage in some individuals, with recent studies suggesting loss of gray matter in multiple regions, particularly in the left hemisphere. There are a number of mechanisms by which COVID-19 infection may lead to neurological symptoms and structural and functional changes in the brain, and it is reasonable to expect that many of these may translate into cognitive problems. Indeed, cognitive problems are one of the most commonly reported symptoms in those experiencing “Long COVID”—the chronic illness following COVID-19 infection that affects between 10 and 25% of patients. The COVID and Cognition Study is a part cross-sectional, part longitudinal, study documenting and aiming to understand the cognitive problems in Long COVID. In this first paper from the study, we document the characteristics of our sample of 181 individuals who had experienced COVID-19 infection, and 185 who had not. We explore which factors may be predictive of ongoing symptoms and their severity, as well as conducting an in-depth analysis of symptom profiles. Finally, we explore which factors predict the presence and severity of cognitive symptoms, both throughout the ongoing illness and at the time of testing. The main finding from this first analysis is that that severity of initial illness is a significant predictor of the presence and severity of ongoing symptoms, and that some symptoms during the initial illness—particularly limb weakness—may be more common in those that have more severe ongoing symptoms. Symptom profiles can be well described in terms of 5 or 6 factors, reflecting the variety of this highly heterogenous condition experienced by the individual. Specifically, we found that neurological/psychiatric and fatigue/mixed symptoms during the initial illness, and that neurological, gastrointestinal, and cardiopulmonary/fatigue symptoms during the ongoing illness, predicted experience of cognitive symptoms.

Epilepsy diagnosis after Covid-19: A population-wide study

“…Specific engagement of the olfactory system appears relatively common, causing anosmia in a majority of patients, and changes in corresponding parts of the brain has been described [3] . Further, neurocognitive impairment is part of the complex syndrome of post-infectious disease called long covid [4] . Case reports of patients with positive SARS-CoV-2 PCR in cerebrospinal fluid (CSF) has been described, but the current consensus is that the virus does not readily infect the brain and that most CNS symptoms are mediated through immunological or metabolic mechanisms [5] .…”

Engineered Wnt7a ligands rescue blood brain barrier and neurobehavioral deficits in a mouse model of COVID-19

“…Neuropsychiatric disorders are epidemiologically but not mechanistically linked with COVID-19 and Long-COVID. Neurocognitive, psychiatric, and motor/sensory disorders are increased after COVID-19, especially in middle-aged and advanced age adults (Graham et al ., 2021; Guo et al, 2022; Nalbandian et al ., 2021; Taquet et al ., 2021). To gain insight into how SARS-CoV-2 infection might modulate neural control of behavior, we analyzed self-grooming behavior in the open field videos (Fig 8H-I).…”

“…Cognitive impairment (“brain fog”), executive function deficit, sensory/motor disorder, anxiety disorders, and fatigue are common cognitive and neuropsychiatric presentations of COVID-19 and Long COVID(Graham et al, 2021; Guo et al, 2022; Nalbandian et al, 2021; Taquet et al, 2021; Visvabharathy et al, 2021). We collectively refer to the neuropathologic, cognitive, and neuropsychiatric presentation of COVID-19 and Long COVID as “NeuroCOVID”.…”

“…Age is an influential factor in presentation of neurological components of Long COVID. Individuals in middle and advanced age are highly susceptible to NeuroCOVID, whereas pediatric populations and adults in the age range 18-30 are more likely to recover from COVID-19 without ongoing symptoms (Guo et al ., 2022; Parisi et al, 2021). Even mild SARS-CoV-2 infection can precipitate ongoing neuroinflammation and neurodegeneration in susceptible age populations.…”

Psychiatric and neurological complications of long COVID

“…In a substantial population of COVID-19 survivors, cognitive deficits were reported. These include concentration problems, short-term memory deficits, general memory loss, a specific decline in attention, language and praxis abilities, encoding and verbal fluency, impairment of executive functions and psychomotor coordination, and an ICD-10 diagnosis of dementia ( Boesl et al, 2021 ; Ceban et al, 2022 ; Fernández-de-Las-Peñas et al, 2022 ; Guo et al, 2022 ; Lauria et al, 2022 ; Miskowiak et al, 2021 ; Nalbandian et al, 2021 ; Sykes et al, 2021 ; Whiteside et al, 2021 ) ( Table 1 ). Among 13,232 of long COVID patients, the pooled proportion of those experiencing cognitive impairment 12 or more weeks after SARS-CoV-2 infection diagnosis was 0.22.…”