Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of cognitive symptoms in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

Abstract

Note: This table is included in the Appendix to provide additional information for clinicians who are treating patients for PASC-related cognitive symptoms. This is not intended to be a comprehensive list, but rather to provide clinical examples as they relate to health equity, health disparities, and social determinants of health. The literature demonstrates that all marginalized groups face socioeconomic barriers and access to care barriers, though these may or may not be barriers for a specific individual patient. People with intersectional identities (eg, those who identify with more than one underrepresented or marginalized group), often face enhanced levels of bias and discrimination. Abbreviation: PASC, postacute sequelae of SARS-CoV-2 infection.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…Post-exertional malaise may be described as “crashing” after several good days, or several days of worsening symptoms after stressors or triggers. Cognitive difficulties or “brain fog” can include impaired attention, concentration, reduced ability to multi-task, difficulty with short-term memory and word-finding difficulties 72 . Some patients may describe increased irritability or emotionally vulnerability.…”

“…Although there are few studies of treatment in Long COVID that have shown efficacy or effectiveness, consensus guidance on best approaches to treat these patients based on the lived experience of patient and clinicians are emerging 71 , 72 , 73 , 80 . The overall approach to treatment of Long COVID is to focus on managing symptoms, improving function, and working with the patient to settle on reasonable treatments targets that have the potential to improve their quality of life.…”

“…speech language pathologist, occupational therapist, neuropsychologist) seems a reasonable treatment approach. 72 The evaluation may focus on the assessment of memory, attention, language, energy and cognitive endurance, sleep, and other symptoms. Patients should be asked about their living situation, their work or school status and what cognitive symptoms are most troubling them.…”

“… Provide patients with physical fatigue, cognitive symptoms and/or post-exertional malaise, educational materials about the importance of energy conservation ⁃4 Ps: Pacing, Prioritization, Planning, Positioning 71 Consider referring patients with cognitive complaints to specialist with expertise in cognitive rehabilitation therapies (e.g. speech therapist, occupational therapist, neuropsychologist) 72 . Assess the impact of the symptoms on the patient’s ability to return to normal daily activities and consider early disability accommodations to facilitate recovery.…”

“…Consider referring patients with cognitive complaints to specialist with expertise in cognitive rehabilitation therapies (e.g. speech therapist, occupational therapist, neuropsychologist) 72 .…”