Covid-19 Cognitive Deficits After Respiratory Assistance in the Subacute Phase: A Covid-Rehabilitation Unit Experience

Abstract

IntroductionCOVID-19 complications can include neurological, psychiatric, psychological, and psychosocial impairments. Little is known on the consequences of SARS-COV-2 on cognitive functions of patients in the sub-acute phase of the disease. We aimed to investigate the impact of COVID-19 on cognitive functions of patients admitted to the COVID-19 Rehabilitation Unit of the San Raffaele Hospital (Milan, Italy).Material and Methods87 patients admitted to the COVID-19 Rehabilitation Unit from March 27th to June 20th 2020 were included. Patients underwent Mini Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Functional Independence Measure (FIM). Data were divided in 4 groups according to the respiratory assistance in the acute phase: Group1 (orotracheal intubation), Group2 (non-invasive ventilation using Biphasic Positive Airway Pressure), Group3 (Venturi Masks), Group4 (no oxygen therapy). Follow-ups were performed at one month after home-discharge.ResultsOut of the 87 patients (62 Male, mean age 67.23 ± 12.89 years), 80% had neuropsychological deficits (MoCA and MMSE) and 40% showed mild-to-moderate depression. Group1 had higher scores than Group3 for visuospatial/executive functions (p=0.016), naming (p=0.024), short- and long-term memory (p=0.010, p=0.005), abstraction (p=0.024), and orientation (p=0.034). Group1 was younger than Groups2 and 3. Cognitive impairments correlated with patients’ age. Only 18 patients presented with anosmia. Their data did not differ from the other patients. FIM (<100) did not differ between groups. Patients partly recovered at one-month follow-up and 43% showed signs of post-traumatic stress disorder.ConclusionPatients with severe functional impairments had important cognitive and emotional deficits which might have been influenced by the choice of ventilatory therapy, but mostly appeared to be related to aging, independently of FIM scores. These findings should be integrated for decision-making in respiratory and neuropsychiatric assistance of COVID-19 patients in the subacute phase of the disease, and show the need for long-term support and psychological treatment of post-COVID-19 patients.

Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation

“…Among 77 COVID-19 patients undergoing acute inpatient rehabilitation, 80.5% of patients demonstrated cognitive impairment, the majority of whom had mild deficits. This number is consistent with studies using neuropsychological assessments to evaluate cognition in hospitalized COVID-19 patients [5][6] and expands on these findings with a larger sample than is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)…”

S1-Leitlinie Long-/Post-COVID

“…Kognitive Defizite, die sowohl im subakuten Stadium als auch im weiteren Verlauf nach COVID-19 häufiger gefunden werden, betreffen planerisches Denken, Konzentration, Gedächtnis- und/oder Sprachleistungen; das trifft in etwa in drei Viertel der Fälle zu, die Rehabilitation in Anspruch nehmen und zwar sowohl bei initial leichten als auch schweren COVID-19-Verläufen, subakut und später (Post-COVID-Syndrom) 167 168 . Pathogenetisch wurden kognitive Störungen beim Long-/Post-COVID-Syndrom mit Hirnstrukturschädigungen im parahippokampalen und orbitofrontalen Kortex sowie auch mit einer leichten globalen Hirnsubstanzminderung in Zusammenhang gebracht 12 .…”

Post-COVID syndrome: A reflection and opinion paper

“…Las manifestaciones neurológicas del síndrome post-CO-VID son frecuentes y variadas. Dentro de ellas, destacaríamos por frecuencia la cefalea, mareo, astenia, anosmia y alteraciones cognitivas [45]. La cefalea es una de las más frecuentes afectando del 2-6% de los pacientes que han padecido COVID-19.…”