Significant cognitive impairment likely associated with COVID-19 infection with relatively nonsevere symptoms

Reeves, Roy R.; Willoughby, Scott G.

doi:10.1515/jom-2021-0195

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Despite small numbers of hospitalized patients in our study, illness severity did not impact risk of cognitive impairment and poor outcomes, which occurred at all levels of COVID-19 severity. While this phenomenon may not be generalizable to the hospitalized or critically ill population, it is congruent with findings of other studies that specifically assessed patients recovering from mild to moderate episodes of COVID-19 [ 21 , 50 – 52 ]. Therefore, even as the presentation of COVID-19 diminishes with the evolution of the pandemic in an immunologically non-naïve population, the post-infectious morbidity burden of cognitive and psychiatric impacts may persist.…”

Section: Discussionsupporting

confidence: 84%

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up

Andronescu,

Richard,

Scher

et al. 2024

PLoS ONE

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Background Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological impairment, it is important to characterize the frequency and predictors of this post-infection phenotype. Methods The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal study assessing the impact of SARS-CoV-2 infection in U.S. Military Healthcare System (MHS) beneficiaries, i.e. those eligible for care in the MHS including active duty servicemembers, dependents, and retirees. Four broad areas of neuropsychological symptoms were assessed cross-sectionally among subjects 1–6 months post-infection/enrollment, including: depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), fatigue (PROMIS® Fatigue 7a), and cognitive function (PROMIS® Cognitive Function 8a and PROMIS® Cognitive Function abilities 8a). Multivariable Poisson regression models compared participants with and without SARS-CoV-2 infection history on these measures, adjusting for sex, ethnicity, active-duty status, age, and months post-first positive or enrollment of questionnaire completion (MPFP/E); models for fatigue and cognitive function were also adjusted for depression and anxiety scores. Results The study population included 2383 participants who completed all five instruments within six MPFP/E, of whom 687 (28.8%) had at least one positive SARS-CoV-2 test. Compared to those who had never tested positive for SARS-CoV-2, the positive group was more likely to meet instrument-based criteria for depression (15.4% vs 10.3%, p<0.001), fatigue (20.1% vs 8.0%, p<0.001), impaired cognitive function (15.7% vs 8.6%, p<0.001), and impaired cognitive function abilities (24.3% vs 16.3%, p<0.001). In multivariable models, SARS-CoV-2 positive participants, assessed at an average of 2.7 months after infection, had increased risk of moderate to severe depression (RR: 1.44, 95% CI 1.12–1.84), fatigue (RR: 2.07, 95% CI 1.62–2.65), impaired cognitive function (RR: 1.64, 95% CI 1.27–2.11), and impaired cognitive function abilities (RR: 1.41, 95% CI 1.15–1.71); MPFP/E was not significant. Conclusions Participants with a history of SARS-CoV-2 infection were up to twice as likely to report cognitive impairment and fatigue as the group without prior SARS-CoV-2 infection. These findings underscore the continued importance of preventing SARS-CoV-2 infection and while time since infection/enrollment was not significant through 6 months of follow-up, this highlights the need for additional research into the long-term impacts of COVID-19 to mitigate and reverse these neuropsychological outcomes.

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Section: Discussionsupporting

confidence: 84%

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up

Andronescu,

Richard,

Scher

et al. 2024

PLoS ONE

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“…Complications involving the CNS and mental health, including cognitive impairment, are becoming more common. Direct neurotoxicity or the host’s immune system are two of the most common causes of cognitive deficits 24 . The patient’s consciousness is also affected by direct inflammation of the CNS due to SARS-CoV-2 and extracranial cardiorespiratory illness.…”

Section: Methodsmentioning

confidence: 99%

Long-term cognitive dysfunction after the COVID-19 pandemic: a narrative review

Shariff,

Uwishema,

Mizero

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has brought a conglomerate of novel chronic disabling conditions described as ‘Long COVID/Post-COVID-19 Syndrome’. Recent evidence suggests that the multifaceted nature of this syndrome results in both pulmonary and extrapulmonary sequelae,chronic dyspnoea, persistent fatigue, and cognitive dysfunction being the most common, debilitating symptoms. Several mechanisms engender or exacerbate cognitive impairment, including central nervous system and extra-central nervous system causes, although the exact mechanism remains unclear. Both hospitalized and non-hospitalized patients may suffer varying degrees of cognitive impairment, ranging from fatigue and brain fog to prolonged deficits in memory and attention, detrimental to the quality-of-life years post-recovery. The aim of this review is to understand the underlying mechanisms, associations, and attempts for prevention with early intervention of long-term cognitive impairment post-COVID-19. Methodology: A systematic search was conducted through multiple databases such as Medline, National Library of Medicine, Ovid, Scopus database to retrieve all the articles on the long-term sequalae of cognitive dysfunction after SARS-CoV-2 infection. The inclusion criteria included all articles pertinent to this specific topic and exclusion criteria subtracted studies pertaining to other aetiologies of cognitive dysfunction. This search was carefully screened for duplicates and the relevant information was extracted and analysed. Results/discussion: To date, the exact pathogenesis, and underlying mechanisms behind cognitive dysfunction in COVID-19, remain unclear, hindering the development of adequate management strategies. However, the proposed mechanisms suggested by various studies include direct damage to the blood-brain barrier, systemic inflammation, prolonged hypoxia, and extended intensive care admissions. However, no clear-cut guidelines for management are apparent. Conclusion: This review of the COVID-19 pandemic has elucidated a new global challenge which is affecting individuals’ quality of life by inducing long-term impaired cognitive function. The authors have found that comprehensive evaluations and interventions are crucial to address the cognitive sequelae in all COVID-19 patients, especially in patients with pre-existing cognitive impairment. Nevertheless, the authors recommend further research for the development of relevant, timely neurocognitive assessments and treatment plans.

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Section: Introductionmentioning

confidence: 99%

“…[5] However, elderly people are at greater risk of severe COVID-19 due to increased risk of comorbidities and cognitive decline in old age, resulting in long-term neuropsychiatric and cognitive deficits. [6,7] The exact mechanism underlying these deficits is unknown, but they seems to be multifactorial. [8] It has been studied that comorbidities such as diabetes mellitus, hypertension, asthma, chronic kidney disease (CKD), heart failure, chronic obstructive pulmonary disease (COPD), and malignancies and human immunodeficiency virus are associated with the increased risk of intensive care unit (ICU) admission and mortality among the elderly patients suffering from COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from academic hospital in Saudi Arabia

et al. 2022

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The coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, of which 5% required intensive care, especially mechanical ventilation. The prognosis depends on several factors including comorbidities. This study was conducted to identify the comorbidities associated with the intensive care unit (ICU) admission in elderly with COVID-19 admitted to a tertiary academic hospital. A retrospective cross-sectional study was conducted at KSUMC including all hospitalized patients (age ≥ 65 years) with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted between March 2020 and August 2021. Data collection included sociodemographic characteristics, underlying comorbidities, and the Charlson comorbidity index. Comorbidities were compared between the elderly patients with COVID-19 admitted to the ICU and those not admitted to the ICU. The odds ratios were calculated and a P value of < .05 and 95% confidence intervals were used to report the statistical significance A total of 444 patients (ICU = 147, non-ICU = 297) were included in the study. The study revealed that elderly patients with COVID-19 admitted to ICU had a higher rate of mortality (n = 64, 67.4%; P < .0001) and a higher proportion of them had shortness of breath (n = 97, 38.3%; P = .007) compared to the elderly patients not admitted to ICU. The mean length of stay ( P < .0001), and weight ( P = .02) among ICU patients were higher than the values for the non-ICU group, while the mean oxygen saturation (SpO2; P = .006) was lower among the ICU group. The comorbidities that demonstrated a statistically significant association with ICU admission were heart failure ( P = .004, odd ratio (OR) = 2.02, 95% confidence intervals (CI) [1.263, 3540]), chronic obstructive pulmonary disease (COPD; P = .027, OR = 3.361, 95% CI [1.080, 10.464]), and chronic kidney disease ( P = .021, OR = 1.807, 95% CI [1.087, 3.006]). The current study identified that the comorbidities such as COPD, heart failure, and factors like SpO2 and length of stay are associated with an increased risk of ICU admission in elderly patients with COVID-19. These findings highlight the clinical implications of comorbidity among geriatric population.

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Significant cognitive impairment likely associated with COVID-19 infection with relatively nonsevere symptoms

Cited by 5 publications

References 19 publications

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up

Long-term cognitive dysfunction after the COVID-19 pandemic: a narrative review

Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from academic hospital in Saudi Arabia

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