Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment

Abstract

Background Cognitive deficits have been increasingly reported as possible long-term manifestations after SARS-CoV-2 infection. Aims In this study we aimed at evaluating the factors associated with cognitive deficits 6 months after hospitalization for Coronavirus Disease 2019 (COVID-19). Methods One hundred and six patients, discharged from a pneumology COVID-19 unit between March 1 and May 30 2020, accepted to be evaluated at 6 months according to an extensive neurological protocol, including the Montreal Cognitive Assessment (MoCA). Results Abnormal MoCA scores at 6 months follow-up were associated with higher pre-hospitalization National Health System (NHS) score (Duca et al. in Emerg Med Pract 22:1–2, 2020) (OR 1.27; 95% CI 1.05–1.6; p = 0.029) and more severe pulmonary disease expressed by the Brescia-COVID Respiratory Severity Scale (Duca et al. in Emerg Med Pract 22:1–2, 2020) (BCRSS > 1OR 4.73; 95% CI 1.53–14.63; p = 0.003) during the acute phase of the disease. Discussion This longitudinal study showed that the severity of COVID-19, indicated by BCRSS, and a complex score given by age and premorbid medical conditions, expressed by NHS, play a major role in modulating the long-term cognitive consequences of COVID-19 disease. Conclusions These findings indicate that the association of age and premorbid factors might identify people at risk for long-term neurological consequences of COVID-19 disease, thus deserving longer and proper follow-up.

High-density EEG sleep correlates of cognitive and affective impairment at 12-month follow-up after COVID-19

“…In contrast to previous findings, we did not observe a relation between disease severity and worse cognitive performance ( Cristillo et al, 2022 ). Although our definition of disease severity was based on the admission ward (ICU vs medical wards) and we did not factor in inflammatory markers or other biochemical indexes, we observed higher depression and PTSD scores in people discharged from medical wards.…”

Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19?

“…Interestingly, we found no relationship between MoCA and scores on the COVID-19 symptom scale, either during acute illness or at time of administration. This contrasts with other published reports which indicate that more severe COVID symptoms at time of infection were associated with poorer NP performance as well as lower scores on the MoCA [ 29 , 30 ].…”

Neuropsychiatric aspects of long COVID: A comprehensive review

“…Cognitive impairment or memory dysfunction is also a common symptom of long COVID. The following patient characteristics were reported as risk factors for cognitive impairment or memory dysfunction: older age, 111 education ≤12 years, 112 Black race, 112 current smoker, 13 high pre‐hospitalization National Health System score, 113 and interaction of baseline functional status and unemployment prior to hospitalization 112 . Moreover, the following conditions during the acute phase of COVID‐19 have been identified as risk factors: non‐admission in ICU, 111 constitutional neuropsychiatric symptoms and psychological distress, 104,111 D‐dimer levels, 35 low arterial oxygen partial pressure/fractional inspired oxygen ratio, 59 and severe pulmonary disease based on the Brescia‐COVID Respiratory Severity Scale 113 .…”

“…The following patient characteristics were reported as risk factors for cognitive impairment or memory dysfunction: older age, 111 education ≤12 years, 112 Black race, 112 current smoker, 13 high pre‐hospitalization National Health System score, 113 and interaction of baseline functional status and unemployment prior to hospitalization 112 . Moreover, the following conditions during the acute phase of COVID‐19 have been identified as risk factors: non‐admission in ICU, 111 constitutional neuropsychiatric symptoms and psychological distress, 104,111 D‐dimer levels, 35 low arterial oxygen partial pressure/fractional inspired oxygen ratio, 59 and severe pulmonary disease based on the Brescia‐COVID Respiratory Severity Scale 113 . On the contrary, a Brazilian cohort study of 425 patients conducted 6–9 months after hospital discharge revealed that psychiatric or cognitive outcomes were neither related to any clinical factors of acute illness severity nor to the psychosocial stressors associated with the illness 46 …”