Neurocognitive deficits in severe COVID-19 infection: Case series and proposed model

Abstract

Objective: To date, very few studies investigating neurocognitive deficits in COVID-19 have been published. This case series addresses cognition in post-COVID-19 patient by describing three patients in acute rehabilitation to inform a model of cognitive sequelae of COVID-19. Methods: Three English-speaking inpatients with severe symptoms and long-term intensive care unit (ICU) treatment are described. All patients had a premorbid history of hypertension and hyperlipidemia and experienced delirium and hypoxemia when hospitalized. Patient 1 is a 62-year-old male with 15 years of education with additional history of obstructive sleep apnea and type 2 diabetes. Patient 2 is a 73-year-old female with 12 years of education with a premorbid medical history of alcohol use disorder and Guillain-Barre syndrome. Patient 3 is a 75-year-old male with 14 years of education. No patients had premorbid psychiatric histories. Results: The three patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. Memory measures improved with a more structured story memory task compared to a lessstructured verbal list-learning task, suggesting executive dysfunction impacted learning. None of the patients demonstrated rapid forgetting of information. Two patients endorsed new depressive and/or anxiety symptoms. Conclusions: The results suggest evidence for neurocognitive deficits after severe COVID-19 infection, particularly in encoding and verbal fluency. These results were interpreted with caution given the limited number of patients and the telephone-based battery. The specific mechanism that caused these cognitive deficits in these individuals remains unclear. A proposed three-stage model of cognitive dysfunction is described to help guide future research.

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

“…The most frequently reported psychiatric deficits were depression and/or anxiety. In total, this was examined in 47 studies ( Al-Aly et al, 2021 , Alemanno et al, 2021 , Boari et al, 2021 , Chen et al, 2020 , Chevinsky et al, 2021 , Daher et al, 2020 , Darley et al, 2021 , Daugherty et al, 2021 , De Lorenzo et al, 2020 , Frontera et al, 2021 , Gennaro et al, 2021 , González et al, 2021 , Halpin et al, 2021 , Huang et al, 2021a , Iqbal et al, 2021 , Lorenzo et al, 2021 , Matalon et al, 2021 , Mattioli et al, 2021 , Mazza et al, 2020 , Mazza et al, 2021 , Méndez et al, 2021 , Monti et al, 2021 , Morin et al, 2021 , Negrini et al, 2021 , Noviello et al, 2021 , Ortelli et al, 2021 , Poyraz et al, 2021 , Romero-Duarte et al, 2021 , Sykes et al, 2021 , Tanriverdi et al, 2021 , Taquet et al, 2021a , Taquet et al, 2021b , Tomasoni et al, 2021 , Townsend et al, 2021 , van den Borst et al, 2020 , Venturelli et al, 2021 , Wang et al, 2020b , Wang et al, 2020c , Whiteside et al, 2021 , Wong et al, 2020 , Wu et al, 2020 , Xiong et al, 2021 , Yuan et al, 2020 , Zhou et al, 2020 , D'Cruz et al, 2021 , de Graaf et al, 2021 , Weerahandi et al, 2021 ). The results range from no indication of depression or anxiety ( Daher et al, 2020 , Zhou et al, 2020 ) to >30% at follow-up ( De Lorenzo et al, 2020 , Frontera et al, 2021 , Iqbal et al, 2...…”

“…Different aspects of cognitive decline were examined in 27 studies ( Al-Aly et al, 2021 , Albu et al, 2021 , Alemanno et al, 2021 , Darley et al, 2021 , Daugherty et al, 2021 , de Graaf et al, 2021 , De Lorenzo et al, 2020 , Gautam et al, 2021 , Gennaro et al, 2021 , Halpin et al, 2021 , Lu et al, 2020 , Mattioli et al, 2021 , Mazza et al, 2021 , Mcloughlin et al, 2020 , Méndez et al, 2021 , Miskowiak et al, 2021 , Monti et al, 2021 , Morin et al, 2021 , Negrini et al, 2021 , Ortelli et al, 2021 , Shang et al, 2021 , Sykes et al, 2021 , Taquet et al, 2021b , van den Borst et al, 2020 , Venturelli et al, 2021 , Whiteside et al, 2021 , Zhou et al, 2020 ). The results range from no cognitive impairments at a 4 months follow-up ( Mattioli et al, 2021 ) to a report of 78% of the patients experiencing impaired performance on at least one cognitive domain 3 months after clinical recovery ( Mazza et al, 2021 ).…”

“…The results range from no cognitive impairments at a 4 months follow-up ( Mattioli et al, 2021 ) to a report of 78% of the patients experiencing impaired performance on at least one cognitive domain 3 months after clinical recovery ( Mazza et al, 2021 ). In total, 11 studies reported cognitive deficits in>25% of their patient populations ( Alemanno et al, 2021 , de Graaf et al, 2021 , De Lorenzo et al, 2020 , Gennaro et al, 2021 , Lu et al, 2020 , Mazza et al, 2021 , Méndez et al, 2021 , Miskowiak et al, 2021 , Negrini et al, 2021 , Sykes et al, 2021 , Whiteside et al, 2021 ). The reported deficits were concentration problems ( Halpin et al, 2021 ), short-term memory deficits ( Halpin et al, 2021 ), general memory loss ( Daugherty et al, 2021 , Lu et al, 2020 , Shang et al, 2021 , Sykes et al, 2021 ), a specific decline in attention, memory, language, and praxis abilities ( Negrini et al, 2021 ), encoding and verbal fluency ( Whiteside et al, 2021 ) and an ICD-10 diagnosis of dementia ( Taquet et al, 2021b ).…”

“…In total, 11 studies reported cognitive deficits in>25% of their patient populations ( Alemanno et al, 2021 , de Graaf et al, 2021 , De Lorenzo et al, 2020 , Gennaro et al, 2021 , Lu et al, 2020 , Mazza et al, 2021 , Méndez et al, 2021 , Miskowiak et al, 2021 , Negrini et al, 2021 , Sykes et al, 2021 , Whiteside et al, 2021 ). The reported deficits were concentration problems ( Halpin et al, 2021 ), short-term memory deficits ( Halpin et al, 2021 ), general memory loss ( Daugherty et al, 2021 , Lu et al, 2020 , Shang et al, 2021 , Sykes et al, 2021 ), a specific decline in attention, memory, language, and praxis abilities ( Negrini et al, 2021 ), encoding and verbal fluency ( Whiteside et al, 2021 ) and an ICD-10 diagnosis of dementia ( Taquet et al, 2021b ). The studies were performed from immediately after recovery (defined as a minimum of 2 negative SARS-CoV-2 PCR tests) ( Zhou et al, 2020 ) until 7 months after the disease ( Gautam et al, 2021 ).…”

“… 22.2% of the women suffered from PTSD or depression at 3 months after delivery or induced abortion Wang et al, 2020b (USA) To evaluate prevalence of psychiatric morbidity following discharge after COVID-19 hospitalization Cross sectional study PTSD-5; GAD-7; CBS-D 10 215 95 (44%) 56 After hospital discharge Previous COVID-19 patients discharged home or to a nursing facility Not reported 34%, 24%, and 42% of patients screened positive for PTSD, anxiety, and depression respectively Weerahandi et al, 2021 (USA) To characterize physical health and mental health of patients 1 month after discharge for severe COVID-19 Cohort study PROMIS survey instruments 152 92 (62.7%) 62 Min 1 month Adult previous O2 requiring COVID-19 patients discharged to home or a facility Communication impairment or baseline dementia, discharged to hospise, residing in long-term care, and rehospitalization One month after COVID-19 infection, both scores in mental health and physical health were significantly lower . Patients also reported worsened ability to carry out social activities after COVID-19 Whiteside et al, 2021 (USA) To investigate neurocognitive sequelae following COVID-19 Case-series WAIS IV; RDS; HVLT-R; RBANS; BDAE; TMT; TSAT; ILS; BAI; GDS 3 2 (67%) 70 2 months English-speaking previous COVID-19 inpatients with severe symptoms, and long-term ICU treatment from a rehabilitation unit Not reported The patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. None of the patients demonstrated rapid forgetting of information.…”