Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series

Abstract

Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances.Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed >7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT).Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15–33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25–10.75) and altered visuospatial construction with a median of four points (IQR 4–9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-CoConclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19.

Cognitive impairment in people with previous COVID-19 infection: A scoping review

“…The mean age of participants ranged from 42.57 ± 7.23 ( Matos et al, 2021 ) to 79 ± 8 ( Pirker-Kees et al, 2021 ), yet in the majority of studies, the mean age was 60 ( Supplementary Material, Fig. F2 ).…”

“…The FAB global score was also impaired in the third study ( Versace et al, 2021 ), reporting that 12/12 non-ICU-admitted subjects performed under the normality cutoff. Finally, one study reported 5/7 subjects with mild COVID-19 performing under the normality cutoff (mean and SD: 5 ± 2.94; max score: 10; cutoff: 9) during the clock drawing test ( Matos et al, 2021 ).…”

Cognitive Impairment in Non-critical, Mild-to-Moderate COVID-19 Survivors

“…However, comparison is difficult as they used a screening test and did not define cognitive impairment (Del Brutto et al, 2021). A case series study of seven mild-to-moderate cases indicated 100% impairment based on screening tests (Matos et al, 2021).…”

“…However, comparison is difficult as they used a screening test and did not define cognitive impairment ( Del Brutto et al, 2021 ). A case series study of seven mild-to-moderate cases indicated 100% impairment based on screening tests ( Matos et al, 2021 ). Further research is needed to determine the incidence and characteristics of cognitive impairment in non-critical COVID-19.…”

Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study

“…which is similar to the findings of the present study. This is especially pertinent given that anxiety has consistently been identified as a key predictor of neurocognitive disorders in several meta-analyses [4,8,10] more than seven days after the onset of the disease [27].…”