Neuropsychological functioning in post-ICU patients after severe COVID-19 infection: The role of cognitive reserve

Abstract

Background Cognitive manifestations associated with Severe Acute Respiratory Syndrome by Coronavirus 2 (SARS-CoV-2) are yet to be described in the existing literature. The aim of this exploratory study is to analyze the impact of severe SARS-CoV-2 infection on neuropsychological performance 6 months following hospital discharge, and to identify which medical variables predict worse outcome. In this context, we study if cognitive reserve (CR) may play a protective role on cognitive impairment. Methods We enrolled a cohort of 102 severe SARS-CoV-2 survivors who had been admitted to the Intensive Care Unit (ICU) and were contacted 6-months post discharge. A total of 58 agreed to participate in this 6-month follow-up study. Patients with previously known cognitive impairment were excluded. Demographic, clinical and laboratory data were collected. Firstly, to test the magnitude of neurocognitive sequalae two standard deviations below normative group were considered. Secondly, to analyze the main effects of medical variables on cognition and the interaction with cognitive reserve, ANCOVA analyses were performed. Results 53.4% obtained a score below the cutoff point (<26) in the screening test MOCA. ICU variables including mechanical ventilation, days of sedation or high CRP days were related with cognition. Cognitive Reserve (CR) interacted with delirium (F = 6.8, p = 0.01) and sedation days (F = 9.40, p = 0.003) to predict verbal memory and interacted with high CRP to predict phonemic fluency (F = 6.47, p = 0.01). Finally, no differences in neuropsychological performance were found depending on subjective cognitive impairment (SCI). However, patients with SCI had a higher score in the HAD anxiety subscale (t = −2.2; p < 0.05). Conclusions In our cohort, cognitive dysfunction was related with ICU variables such as delirium, mechanical ventilation, and inflammation. CR modulated the impact of these variables on cognition. Cognitive complaints were related with anxiety but not with cognitive performance. Despite some limitations, including the need of replication of the findings with larger samples and control groups, our study suggests that high CR may be protective for severe COVID-19-related cognitive impairment.

WITHDRAWN: Investigation and analysis of cognitive function and psychological status in stroke patients with COVID-19

“…Through Kruskal wallish test, we found that patients with COVID-19 infection are indeed related to prognosis anxiety and depression, which will increase the psychological burden. A study found that novel coronavirus pneumonia patients may have some type of cognitive impairment in the long term, especially in the areas of processing speed, verbal memory or executive function 14 . Our study found that novel coronavirus pneumonia is associated with stroke and cognitive impairment also in mild and non severe infection, but not only in severe infection.…”

A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome

“…Chronic activation of the extended autonomic system, including the neuroendocrine and neuroimmune systems, would be associated with an increased risk of developing Long-COVID [ 29 , 89 ]. As mentioned before, SARS-CoV-2 could reach the hypothalamus and activate brain mast cells and microglia to release pro-inflammatory molecules [ 3 , 10 ]. In turn, the autonomic alteration of hypothalamus function may determine cognitive abnormality, sleep dysregulation, and profound fatigue.…”

“…Long-COVID syndrome consists of many persistent symptoms following COVID-19 illness, which can endure for several weeks or months [ 1 ]. It is estimated to affect at least one-third of patients, with a prevalence increasing in patients hospitalized because of COVID-19 infection [ 2 , 3 ]. One of the most frequent Long-COVID effects is brain fog [ 4 ], a colloquial expression indicating a phenomenon whose clinical impact may be detrimental to an individual’s psychological, occupational, and social life.…”

Multidomain cognitive impairment in non-hospitalized patients with the post-COVID-19 syndrome: results from a prospective monocentric cohort

“…Still, data so far do not suggest that post-COVID-19 is explained by persisting central nervous system infection [ 45 ], leaving brain imaging alterations observed largely unexplained [ 53 ]. Other possible aspects may include immune-mediated [ 48 , 54 ], neurodegenerative, hypoxia-related [ 55 , 56 ] or metabolic changes related [ 45 , 57 ] causes. Furthermore we should not neglect possible complex multifactorial explanations including psychiatric network perspectives [ 49 ].…”