Changes in psychological and cognitive variables as well as cortisol levels in recovered Covid-19 patients: a longitudinal study

Abstract

Background: Decreased psychological and cognitive functioning is one of the complications of Covid-19 disease. We aimed to evaluate mental health, cognitive functioning, and salivary cortisol levels in Covid-19 patients with different disease severities in three 45-day intervals after recovery. Methods: 258 Covid-19 patients were assigned into three groups based on their disease severity: 112 patients in mild group, 67 patients in moderate group and 79 patients in severe group. The participants underwent psychological evaluations (including Depression, Anxiety and Stress Scale questionnaire, Beck Depression Inventory, SpeilBerger State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Inventory), cognitive assessments (The Paced Auditory Serial Addition Test) and salivary cortisol level evaluation in three 45-day periods. Non-parametric statistical methods were applied for psychological and cognitive indicators, while two-way mixed model ANOVA was used to evaluate the cortisol concentration in three replications. Results: The group of mild patients became more anxious and the group of moderate patients became more anxious and depressed. But all three groups of patients developed severe sleep disorders over time. For cognitive functioning, although the results showed a decrease in the correct response rate, a significant increase in the correct response rate was observed in all three groups in all three measurements. However, the response speed not only did not increase, but also decreased in severe group. Cortisol level had a markedly increasing trend in all three groups. Conclusion: Improvement of cognitive functioning was in line with the increase in cortisol. Besides, the decrease in mental health had no effect on the cognitive functioning.

Socio-demographic and clinical predictors of post-acute, mid-and long-term psychological sequelae of COVID-19: A two-year cross-sectional investigation on 1317 patients at the University Hospital of Verona

“…Although counterintuitive at rst sight, this observation becomes more understandable if we consider that the pandemic has tested public health services, which have not been able to guarantee the psychological and psychiatric support necessary for situations of mild or modest severity, as the resources necessarily had to be allocated towards the more critical conditions. Arguably, this means that COVID-19 survivors who suffered from mild to moderate anxious or depressive symptoms, that were not adequately addressed, continued to manifest these symptoms even many months later, as suggested elsewhere [58, 70,39].…”

“…Furthermore, although the WHO de nition considers the three-month term after the infection, some studies have reported the presence of at least one psychological symptom six months after the infection [29,30], or between six and twelve months [31][32][33][34][35][36][37], with some symptoms appearing to show a worsening trend over time [38,39]. Interestingly, two recent studies suggested the presence of physical (i.e., fatigue, dyspnea, headache, myalgia among the most reported) and psychological (i.e., anxiety, depression, cognitive problems, and sleep disturbance symptoms) consequences of COVID-19 after two years from the infection [40,41].…”

Exploring the Pathophysiology of Long COVID: The Central Role of Low-Grade Inflammation and Multisystem Involvement

“…Another aspect of canonical inflammation in LC, which was not included in the aims and objectives of our study, is considering LC as a risk factor for the onset of various inflammatory diseases or the progression of existing inflammatory diseases [ 323 , 324 , 325 , 326 , 327 ]. This primarily concerns immune-dependent diseases, whose association has been established, namely various allergic, autoimmune, and infectious diseases, but also should be taken into account in other pathological conditions as well [ 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 , 281 ,…”

“…Furthermore, hypocortisolemia and hypoactivation of the HPA axis reported in LC are also reminiscent of what was previously described in 2005 in the post-SARS ‘sickness syndrome’ type condition characterized by symptoms such as malaise, anorexia, fatigue, and myalgias [ 246 ]. Improvement in cognitive functioning correlates with increased cortisol levels [ 247 ]. Furthermore, plasma cortisol levels have a significant negative correlation with fatigue scores and a positive correlation with quality of life [ 248 ].…”