From ‘mental fog’ to post-acute COVID-19 syndrome's executive function alteration: Implications for clinical approach

Pallanti, Stefano; Di Ponzio, Michele; Gavazzi, Gioele; Gasic, Gregory; Besteher, Bianca; Heller, Carina; Kikinis, Ron; Makris, Nikos; Kikinis, Zora

doi:10.1016/j.jpsychires.2023.09.017

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…It was somewhat unexpected that participants performed largely within normal limits on the Oral Trail Making Test Part B, given that this measure is thought to assess abilities involving frontal network functions, including executive attention and set shifting. Furthermore, research has demonstrated that patients with PASC perform poorly on the Written Trail Making Test Part B ( 19 , 40 , 43 ). However, the Written and Oral Trail Making Test Part B have been found to index slightly different cognitive constructs and are not considered fully convergent measures ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status

Cahan,

Finley,

Cotton

et al. 2024

Front. Neurol.

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This study sought to characterize cognitive functioning in patients with neurological post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) and investigate the association of subjective and objective functioning along with other relevant factors with prior hospitalization for COVID-19. Participants were 106 adult outpatients with Neuro-PASC referred for abbreviated neuropsychological assessment after scoring worse than one standard deviation below the mean on cognitive screening. Of these patients, 23 had been hospitalized and 83 had not been hospitalized for COVID-19. Subjective cognitive impairment was evaluated with the self-report cognition subscale from the Patient-Reported Outcome Measurement Information System. Objective cognitive performance was assessed using a composite score derived from multiple standardized cognitive measures. Other relevant factors, including fatigue and depression/mood symptoms, were assessed via the Patient-Reported Outcome Measurement Information System. Subjective cognitive impairment measures exceeded the minimal difficulties noted on objective tests and were associated with depression/mood symptoms as well as fatigue. However, fatigue independently explained the most variance (17.51%) in patients’ subjective cognitive ratings. When adjusting for fatigue and time since onset of COVID-19 symptoms, neither objective nor subjective impairment were associated with prior hospitalization for COVID-19. Findings suggest that abbreviated neuropsychological assessment may not reveal objective difficulties beyond initial cognitive screening in patients with Neuro-PASC. However, subjective cognitive concerns may persist irrespective of hospitalization status, and are likely influenced by fatigue and depression/mood symptoms. The impact of concomitant management of fatigue and mood in patients with Neuro-PASC who report cognitive concerns deserve further study.

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Section: Discussionmentioning

confidence: 99%

Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status

Cahan,

Finley,

Cotton

et al. 2024

Front. Neurol.

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“…Although no symptom scale ratings were obtained to measure anxiety symptoms, insomnia, and mood, the patient's wife who is his primary caregiver attested to significant improvement in these facets with IVIG infusions. Given the improvement in his behavioral symptoms and sleep with IVIG infusions, it is possible that these symptoms share neuroinflammatory pathophysiology with the cognitive symptoms, in the context of COVID-19 [ 18 ]. Neuroinflammation in the aftermath of COVID-19 is associated with neurological, and behavioral symptoms in addition to cognitive deficits [ 3 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Naeem,

Oros,

Adams

et al. 2023

Cureus

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Coronavirus disease 2019 (COVID-19) is associated with long-term neuropsychiatric sequelae. We describe a 60-year-old male patient's history and symptom trajectory encompassing the development of behavioral symptoms and cognitive deficits following pneumonia and subsequent autoimmune encephalitis associated with COVID-19. We also describe changes in these facets with correlative changes in his immunological parameters after both acute intravenous immunoglobulin (IVIG) therapy and chronic periodic IVIG therapy every two weeks over the course of two years. We review the literature on the treatment of long COVID-19 symptoms spanning cognitive and behavioral domains. In addition, we also elucidate current literature on the role of IVIG infusions for these symptoms using our patient's presentation and improvement in symptoms as an illustrative example.

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Evolving trends in neuropsychological profiles of post COVID-19 condition: A 1-year follow-up in individuals with cognitive complaints

Grunden,

Calabria,

García-Sánchez

et al. 2024

PLoS ONE

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Cognitive difficulties are reported as lasting sequelae within post COVID-19 condition. However, the chronicity of these difficulties and related factors of fatigue, mood, and perceived health have yet to be fully determined. To address this, the current longitudinal study aimed to clarify the trends of cognitive test performance and cognitive domain impairment following COVID-19 onset, and whether hospitalization influences outcomes. 57 participants who reported subjective cognitive difficulties after confirmed COVID-19 infection were assessed at baseline (~6 months post COVID-19) and follow-up (~15 months later) visits. Assessments included measures across multiple cognitive domains and self-report questionnaires of fatigue, mood, and overall health. Analyses were conducted in three stages: at the test score level (raw and adjusted scores), at the cognitive domain level, and stratified by hospitalization status during infection. Results at the test-score level indicate that cognitive performance remains relatively stable across assessments at the group level, with no significant improvements in any adjusted test scores at follow-up. Cognitive domain analyses indicate significant reductions in attention and executive functioning impairment, while memory impairment is slower to resolve. On self-report measures, there was a significant improvement in overall health ratings at follow-up. Finally, those hospitalized during infection performed worse on timed cognitive measures across visits and accounted for a larger proportion of cases with short-term and working memory impairment at follow-up. Overall, our findings indicate that cognitive difficulties persist both at test score and cognitive domain levels in many cases of post COVID-19 condition, but evidence suggests some improvement in global measures of attention, executive functioning and overall self-rated health. Furthermore, an effect of hospitalization on cognitive symptoms post COVID-19 may be more discernible over time.

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From ‘mental fog’ to post-acute COVID-19 syndrome's executive function alteration: Implications for clinical approach

Cited by 3 publications

References 38 publications

Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status

Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Evolving trends in neuropsychological profiles of post COVID-19 condition: A 1-year follow-up in individuals with cognitive complaints

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