Post-COVID-19 fatigue: the contribution of cognitive and neuropsychiatric symptoms

Abstract

Fatigue in its many forms of physical, mental, and psychosocial exhaustion is a common symptom of post-COVID-19 condition, also known as “Long COVID.” Persistent fatigue in COVID-19 patients is frequently accompanied by cognitive dysfunction and neuropsychiatric symptoms; however, less is known about the relationships between these components of post-COVID-19 condition and fatigue itself. Consequently, the present study sought to (1) distinguish the types of fatigue experienced by participants, and (2) investigate whether cognitive deficits across various domains and neuropsychiatric conditions predicted these different types of fatigue. The study included 136 COVID-19 patients referred for neuropsychological evaluation due to cognitive complaints 8 months on average after SARS-CoV-2 infection. Measures included self-reported fatigue (physical, cognitive, and psychosocial), neuropsychiatric questionnaires (assessing symptoms of depression, anxiety, apathy, and executive functioning), a comprehensive neuropsychological assessment, and self-reported quality of life and everyday functioning. Results showed that reports of clinical significant fatigue were pervasive in our sample (82.3% of participants), with physical fatigue rated highest on average relative to the subscale maximum. Elevated levels of apathy, anxiety, and executive dysfunction in neuropsychiatric measures along with executive and attentional difficulties on cognitive tests were found to be consistently important predictors among different types of fatigue. This implicates both cognitive and neuropsychiatric symptoms as predictors of fatigue in post-COVID-19 condition, and stresses the importance of a holistic approach in assessing and considering potential treatment for COVID-19 patients experiencing fatigue.

Neuropsychological Predictors of Fatigue in Post-COVID Syndrome

“…Central fatigue has previously been associated with the activity of several brain regions and networks. Specifically, a recent study suggested the involvement of the striatum of the basal ganglia, the dorsolateral prefrontal cortex, the dorsal anterior cingulate, the ventromedial prefrontal cortex, and the anterior insula [40]. Of these regions, the anterior cingulate, ventromedial prefrontal cortex, and anterior insula could have a more prominent role [38,41].…”

Post-viral fatigue in COVID-19: A review of symptom assessment methods, mental, cognitive, and physical impairment

“…Although there is an association between pain and fatigue, the causal association is not fully clarified( Fishbain et al, 2003 ). These findings demonstrate the need to evaluate different constructs in patients with persistent post-COVID-19 fatigue and understand the factors associated with the physical, mental, and psychological aspects of fatigue( Calabria et al, 2022 ).…”

Effect of Ultra-Micronized Palmitoylethanolamide and Luteolin on Olfaction and Memory in Patients with Long COVID: Results of a Longitudinal Study

“…Although the pathogenesis of brain fog is not fully understood, it has been linked to neuroinflammation associated with the spread of SARS-CoV-2 to the higher brain centers. Brain fog is thought to primarily arise from the diffusion of inflammation within the olfactory bulbs to other brain regions or, less commonly, from the direct infection of parenchymal brain tissue; systemic inflammation induced by SARS-CoV-2 might also have a role [ 5 , 6 , 7 , 8 ].…”