The Combined Use of Neuropsychiatric and Neuropsychological Assessment Tools to Make a Differential Dementia Diagnosis in the Presence of “Long-Haul” COVID-19

Abstract

The longer term neurocognitive/neuropsychiatric consequences of moderate/severe COVID-19 infection have not been explored. The case herein illustrates a complex web of differential diagnosis. The onset, clinical trajectory, treatment course/response, serial neuroimaging findings, and neuropsychological test data were taken into account when assessing a patient presenting 8 months post-COVID-19 (with premorbid attention-deficit hyperactivity disorder, diabetes mellitus, mood difficulties, and a positive family history of vascular dementia). Her acute COVID-19 infection was complicated by altered mental status associated with encephalopathy and bacterial pneumonia. After recovery from COVID-19, the patient continues to experience persisting cognitive and emotive difficulties despite an ongoing psychopharmacotherapy regimen (16 + years), psychotherapy (15 + sessions), and speech-language pathology SLP; 2 × week/for 12 weeks). The purpose of her most recent and comprehensive neuropsychological evaluation was to determine the presence/absence of neurocognitive disorder. The patient is a 62-year-old Caucasian woman. Cognitive screening was completed 3 months post-acute COVID-19 as part of an SLP evaluation, and a full neuropsychological evaluation was conducted 8 months post-COVID-19 recovery on an outpatient basis (in person). The patient had serial neuroimaging. Initial neurological evaluation during acute COVID-19 included unremarkable brain computed tomography (CT)/magnetic resonance imaging. However, follow-up CT (without contrast) revealed, in part, “asymmetric perisylvian atrophy on the left.” Full neuropsychological evaluation at 8 months post-COVID-19 recovery revealed a dysexecutive syndrome characterized by language dysfunction and affective theory-of-mind deficit, consistent with dementia. There is need for careful use of differential diagnosis in COVID-19 patients with multiple risk factors that make them more susceptible to long-term neurological complications post-COVID-19. Differential diagnosis should involve multidisciplinary assessment (e.g., neuropsychology, SLP, neurology, and psychiatry).

Demenz-Screening- und testpsychologische Untersuchungen in deutschen Haus- und Facharztpraxen unter Bedingungen der Corona Pandemie

“…[8]). Darüber hinaus stellt sich das Problem, kognitive Störungen bei Long-COVID Syndromen von denen einer beginnenden Demenz mittels TPU zu unterscheiden [9,10] oder die langfristigen Verläufe kognitiver Störungen durch wiederholte TPU zu begleiten [11,12]. Zu berücksichtigen ist auch, dass durch Quarantänemaßnahmen geänderte Lebensbedingungen sich auf die Ausprägung neuro-kognitiver Störungen auswirken können [13].…”

Role of Demyelination in the Persistence of Neurological and Mental Impairments after COVID-19

“…Elderly patients are among the most vulnerable populations facing COVID-19 infection. Cognitive complaints are frequent in elderly patients after COVID-19 [ 51 , 52 ] and verse versa, patients suffering from dementia are at higher risk of COVID-19 infection and higher risk of severe forms and hospitalization [ 53 ]. The meta-analysis on the risks associated with COVID-19 infection showed that suffering from dementia increases by 2 to 3 the risk of contracting COVID-19 compared with patients of comparable age [ 54 ].…”

Neurological Consequences, Mental Health, Physical Care, and Appropriate Nutrition in Long-COVID-19

“…It is interesting to observe that these injuries are shared with some neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), optic neuritis and multiple sclerosis. Of interest, some authors have advanced the hypothesis that SARS-CoV-2 infection can cause the development or progression of neurodegenerative diseases (Light 2022 ; Zarifkar et al 2022 ). Once again, the link between SARS-CoV-2-induced disorders and neurodegenerative diseases is being questioned.…”