Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild <scp>COVID</scp>‐19

Apple, Alexandra C.; Oddi, Alexis; Peluso, Michael J.; Asken, Breton M; Henrich, Timothy J.; Kelly, John D.; Pleasure, Samuel J.; Deeks, Steven G.; Allen, Isabel Elaine; Martin, Jeffrey N.; Ndhlovu, Lishomwa C.; Miller, Bruce L.; Stephens, Melanie; Hellmuth, Joanna

doi:10.1002/acn3.51498

Cited by 74 publications

(66 citation statements)

References 21 publications

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“…These include innate and adaptive immune dysregulation [17][18][19][20], autoimmunity [21][22][23], human herpes virus reactivation [24], and microvascular dysfunction [25,26], among others [24]. Certain sociodemographic factors (e.g., income status, access to care) [27,28] and a greater number and/or certain types of medical comorbidities (e.g., obesity, diabetes mellitus, pre-existing cardiovascular or neurologic disease) [27,29,30] may also increase the likelihood of an individual developing PASC. Higher prevalence of such factors among PWH [31,32], along with differences in immune responses to SARS-CoV-2 [14,15] and chronic inflammation and immune dysregulation even in the presence of antiretroviral therapy [33][34][35][36][37][38][39], may make PWH selectively vulnerable to developing persistent COVID-19-attributed symptoms following SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

Peluso

Spinelli

Deveau

et al. 2022

Preprint

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Background: Limited data are available on the long-term clinical and immunologic consequences of SARS-CoV-2 infection in people with HIV (PWH). Methods: We measured SARS-CoV-2 specific humoral and cellular immune responses in people with and without HIV recovering from COVID-19 (n=39 and n=43, respectively) using binding antibody, surrogate virus neutralization, intracellular cytokine staining, and inflammatory marker assays. We identified individuals experiencing symptomatic post-acute sequelae of SARS-CoV-2 infection (PASC) and evaluated immunologic parameters. We used linear regression and generalized linear models to examine differences by HIV status in the magnitude of inflammatory and virus-specific antibody and T cell responses, as well as differences in the prevalence of PASC. Results: Among PWH, we found broadly similar SARS-CoV-2-specific antibody and T cell immune responses as compared with a well-matched group of HIV-negative individuals. PWH had 70% lower relative levels of SARS-CoV-2 specific memory CD8+ T cells (p=0.007) and 53% higher relative levels of PD-1+ SARS-CoV-2 specific CD4+ T cells (p=0.007). Higher CD4/CD8 ratio was associated with lower PD-1 expression on SARS-CoV-2 specific CD8+ T cells (0.34-fold effect, p=0.02). HIV status was strongly associated with PASC (odds ratio 4.01, p=0.008), and the proportion of PD-1+ CD4+ T cells and levels of certain inflammatory markers (IL-6, TNF-alpha, and IP-10) were associated with persistent symptoms. Conclusions: We identified potentially important differences in SARS-CoV-2-specific CD4+ and CD8+ T cells that might have implications for long-term immunity conferred by natural infection. HIV status strongly predicted the presence of PASC. Larger and more detailed studies of PASC in PWH are urgently needed.

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Section: Introductionmentioning

confidence: 99%

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

Peluso

Spinelli

Deveau

et al. 2022

Preprint

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“…Over 75% of 18 patients in a study with mild to moderate disease were found to have the cognitive deficits listed above, indicating that cognitive impairment can even effect those with mild disease [ 26 ]. Cognitive impairments in areas of working memory, executive functioning, memory, visuospatial ability, abstraction, and orientation have also been found [ 17 , 27 ]. Recovery in some or most of these areas in the post-acute phase of the illness has been demonstrated [ 28 ]; however, there are persisting deficits seen in this phase, including patients who were not hospitalized [ 29 ].…”

Section: Neurocognitive and Functional Outcomementioning

confidence: 99%

“…A neuropsychological evaluation can be useful in determining areas of decrement in order to direct treatments, including recommendations for psychotherapy, medication management, and physical, speech, and occupational therapies [ 33 ]. Objective cognitive assessments have been found as a more reliable means to detect the presence of cognitive PASC versus subjective assessment or self-report [ 27 ].…”

Section: Neurocognitive and Functional Outcomementioning

confidence: 99%

“…It is common for psychiatric symptoms to develop after infection from COVID-19; primarily depression, anxiety, and symptoms of PTSD present in both the acute and post-acute course of the illness [ 27 , 40 – 42 ]. Data demonstrates an increased risk, when compared to other medical illnesses, of a psychiatric diagnosis within 90 days of a patient receiving a positive test result [ 43 ••].…”

Section: Neurocognitive and Functional Outcomementioning

confidence: 99%

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Rehabilitation Strategies for Cognitive and Neuropsychiatric Manifestations of COVID-19

Rolin

Chakales

Verduzco‐Gutierrez

2022

Curr Phys Med Rehabil Rep

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Purpose of Review Extrapulmonary manifestations of COVID-19 are abundant, including after recovery of acute SARS-CoV-2 infection. This review seeks to explore the cognitive and neuropsychiatric manifestations of COVID-19 and post-acute sequelae of SARS-CoV-2 (PASC), including Long COVID syndromes. Furthermore, the review will discuss rehabilitation strategies for the emerging neurological consequences of COVID-19 to help those experiencing long-term effects of COVID-19. Recent Findings There is emerging evidence depicting the neural involvement of COVID-19. Health priorities have shifted from understanding pathogenesis and treatment of pulmonary symptoms to targeting the acute and chronic sequelae of COVID-19, including cognitive and neuropsychiatric symptoms. The sequelae of COVID-19 often co-occur with other medical problems and is best managed by assessment and care across multiple disciplines. Symptoms following infection are similar to those found by other syndromes and disorders that disrupt the central nervous system. Summary The acute and chronic sequelae of COVID-19 have become major targets of current health care providers given its significant public health impact, inclusive of cognitive and neuropsychiatric sequelae. Assessment and referral to rehabilitation based on each individual’s needs and symptoms can decrease morbidity and improve quality of life.

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“…The pathogenesis of post-COVID syndrome remains unknown. Several mechanisms have been suggested, including prolonged inflammation, vascular injury and endothelial dysfunction, sequelae of organ damage, and the effects of hospitalisation [ 4 , 5 , 6 ]. Due to the heterogeneity of clinical symptoms, multiple mechanisms may be involved.…”

Section: Introductionmentioning

confidence: 99%

Examining Association of Personality Characteristics and Neuropsychiatric Symptoms in Post-COVID Syndrome

et al. 2022

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Background: We aimed to evaluate personality traits in patients with post-COVID syndrome, as well as the association with neuropsychiatric symptoms present in this disorder. Methods: The Big Five Structure Inventory was administered to 93 consecutive patients with a diagnosis of post-COVID syndrome as defined by the WHO and to demographically matched controls. We also performed a comprehensive evaluation of depression, anxiety, fatigue, sleep quality, cognitive function, and olfactory function. Results: Patients with post-COVID syndrome scored lower for emotional stability, equanimity, positive mood, and self-control. Extraversion, emotional stability, and openness correlated negatively with anxiety and depression levels. Conscientiousness correlated negatively with anxiety. No statistically significant correlations were observed between personality traits and cognitive function, sleep quality, olfactory function, or fatigue. Personality scores explained 36.3% and 41% of the variance in scores on the anxiety and depression scales, respectively. Two personality profiles with lower levels of emotional stability were associated with depression and anxiety. Conclusions: Our study shows higher levels of neuroticism in patients with post-COVID syndrome. Personality traits were predictive of the presence of depression and anxiety, but not cognitive function, sleep quality, or fatigue, in the context of post-COVID syndrome. These findings may have implications for the detection of patients at risk of depression and anxiety in post-COVID syndrome, and for the development of preventive and therapeutic interventions.

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Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID‐19

Cited by 74 publications

References 21 publications

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

Rehabilitation Strategies for Cognitive and Neuropsychiatric Manifestations of COVID-19

Examining Association of Personality Characteristics and Neuropsychiatric Symptoms in Post-COVID Syndrome

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