Author response to “post-infection cognitive impairments in a cohort of elderly patients with COVID-19”

Liu, Yuhui; Wang, Ye‐Ran; Wang, Qinghua; Liu, Juan; Wang, Yan‐Jiang

doi:10.1186/s13024-022-00565-5

Cited by 10 publications

(19 citation statements)

References 11 publications

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“…This method of follow-up may not be as accurate as face-to-face interviews, although telephone-based questionnaires have been validated. 9,15,17 Second, the lack of cognitive information before SARS-CoV-2 infection is an inherent limitation of this study that may lead to an overestimation of the impact of COVID-19 on postinfection cognitive decline. As cognitive decline might be affected by both preexisting cognitive impairment and COVID-19, we excluded participants with known preexisting cognitive impairment and a family history of dementia.…”

Section: Limitationsmentioning

confidence: 97%

“…Inclusion and exclusion criteria were described in our previous study. 9 Briefly, patients were eligible for participation if they were 60 years and older and agreed to participate. Participants were excluded if they met the following conditions: (1) did not agree to participate, did not understand the items in the questionnaires, or had communicative obstacles owing to language or hearing reasons; (2) had self-reported or diagnosed cognitive impairment preinfection; (3) had a family history of dementia in first-degree relatives; (4) had a concomitant neurological disorder potentially affecting cognitive function; or (5) had severe cardiac, hepatic, or kidney diseases or any kind of tumor.…”

Section: Participantsmentioning

confidence: 99%

“…Telephone interviews were conducted to assess cognition by a group of trained raters (L.-R.W., L.J., Y.Y., X.C., Y.L., Y.C). Current cognitive status was assessed using the Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40), 9,15 which includes 10 variables and has a maximum of 40 points. A score of 20 or lower was considered indicative of mild cognitive impairment (MCI), and a score of 12 or lower was considered indicative of dementia.…”

Section: Cognitive Assessmentmentioning

confidence: 99%

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One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

et al. 2022

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IMPORTANCE Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy.OBJECTIVE To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors.DESIGN, SETTING, AND PARTICIPANTS This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines. MAIN OUTCOMES AND MEASURES The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories: stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline.RESULTS Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control , 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities. CONCLUSIONS AND RELEVANCEIn this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the import...

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Section: Limitationsmentioning

confidence: 97%

Section: Participantsmentioning

confidence: 99%

Section: Cognitive Assessmentmentioning

confidence: 99%

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One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

et al. 2022

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“…However, while there is preliminary evidence of post-infectious cognitive decline, long-term cognitive consequences are still not well established in the literature. Recently, Liu et al (14) reported that both severe and non-severe COVID-19 survivors experienced cognitive difficulties and almost 60% of severe COVID-19 survivors displayed longitudinal cognitive decline. In another study, executive dysfunction, apathy and cognitive fatigue were reported in people following COVID-19 infection (15).…”

Section: Discussionmentioning

confidence: 99%

The Link Between COVID-19 and Executive Functions in the Geriatric Population: A Descriptive Cross-Sectional Study

Çebi

KAPLAN

2023

Acibadem Univ Saglik Bilim Derg

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Background: Geriatric population is known to be at a greater risk for the Coronavirus-19 (COVID-19). Previous literature provided evidence for the association between viral infections and cognitive decline. The aim of this study was to evaluate executive functions in older adults who were infected by COVID-19. Methods: A total of 47 participants with healthy cognition over the age of 65 (M:75.4±5.91, minimum-maximum:65-85) were enrolled in the study. The sample was selected from older adults residing in a nursing home in Istanbul. Based on their history of COVID-19 infection, the sample was divided into two groups as COVID-P (22 participants who got Covid-19 in the last six months) and COVID-N (25 participants who did not get Covid-19) which did not significantly differ in terms of age and education. A mini mental state examination was applied to verify the mental status of participants. Trail Making Test (TMT) and Clock Drawing test (CDT) were used to assess executive functions. Results: The analyses showed that COVID-P group displayed significantly lower performance in the completion of both forms of TMT as compared to COVID-N group (p< .05 for both TMT-A and TMT-B). However, groups did not significantly differ in their CDT performance (p> .05). Conclusion: Based on the findings, it is possible to conclude that COVID-19 can negatively affect the executive functions in the old age population.

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“…They also found no significant difference in the proportion of cases with dementia or mild cognitive impairment in people with nonsevere infection compared with controls ( p = 0.703 and 0.123, respectively). 31 A large retrospective review of electronic medical record diagnoses found a new diagnosis of dementia after COVID-19 in only 0.67%; however, when illness severity was taken into consideration, the frequency increased to 4.72% in patients with encephalopathy. 32 A recent retrospective review of over 6 million adults ≥ 65 years old found an increased risk of dementia after COVID-19 infection (hazard ratio, 1.69; CI, 1.53–1.72) and risk positively associated with increasing age and female gender.…”

Section: Neurological Features Of Long Covidmentioning

confidence: 99%

A Review of Neurological Symptoms in Long COVID and Clinical Management

Navis

2023

Semin Neurol

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Long COVID is a clinical diagnosis generally referring to the persistence or development of new symptoms, affecting multiple organ systems after SARS-CoV-2 COVID-19 infection. Long COVID is thought to affect ∼20% of people after infection, including all age ranges and severity of infection. Fatigue, postexertional malaise, and respiratory and cardiac symptoms are commonly described. Neurological symptoms such as cognitive changes, sensory disturbances, headaches, and dysautonomia are common as well. The underlying pathophysiology remains unclear but immune dysregulation, autoimmunity, persistent viral reservoirs, and microvascular dysfunction have been implicated. As there are no tests at this time to diagnose long COVID, work-up should be focused on assessing reversible or treatable causes of symptoms. Furthermore, no treatments for long COVID currently exist, and management remains focused on a multimodal approach and symptom management, with many people showing improvement in symptoms over time.

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Author response to “post-infection cognitive impairments in a cohort of elderly patients with COVID-19”

Cited by 10 publications

References 11 publications

One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

The Link Between COVID-19 and Executive Functions in the Geriatric Population: A Descriptive Cross-Sectional Study

A Review of Neurological Symptoms in Long COVID and Clinical Management

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