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

Abstract

ImportancePrevious studies of post-acute COVID-19 syndrome have focused on critical cases with severe disease. However, most cases are mild to moderate in disease severity.ObjectiveWe aimed to examine cognitive outcomes in cases of non-critical, mild-to-moderate COVID-19. Design, Setting, and Participants: In this cross-sectional study, we enrolled 72 adults aged 22 to 65 years in Central Texas who had non-critical, mild-to-moderate COVID-19 infection between 13 January 2021 and 20 April 2021.Main Outcomes and MeasuresWe remotely administered cognitive-behavioral testing to determine the frequency of cognitive impairment and examine demographic, clinical, and psychosocial contributors to impairment.ResultsThe frequency of objective cognitive impairment was 40%. The largest number of participants (24%) showed impairment on a measure of executive functioning. Attention and processing speed was more impaired in males (OR = 1.5, 95%CI = 0.23–2.9). Males endorsed lower adherence to social distancing guidelines (U = 590, p = 0.01), which was in turn associated with cognitive impairment across participants (r = −0.30, p = 0.01). Younger age was correlated with impairment (r = −0.26, p = 0.03) but was also associated with racial/ethnic minority status (r = −0.31, p = 0.01) and increased psychological symptoms (p < 0.04). Greater number of COVID-19 symptoms was correlated with lower subjective cognitive function (r = −0.38, p = 0.001) as well as psychosocial function (r > 0.24, p < 0.05). Moderate COVID-19 severity was associated with attention/processing speed impairment (r = 0.27, p = 0.03), increased pain (r = 0.31, p = 0.01), and higher number of COVID-19 symptoms (r = 0.32, p = 0.01).Conclusion and RelevanceMild or moderate COVID-19 infection may be associated with cognitive impairments, especially in the domain of executive functioning. A subgroup of younger individuals may be more vulnerable to cognitive and psychosocial effects of COVID-19.HighlightsQuestion: How frequent is cognitive impairment among non-critical, mild-to-moderate COVID-19 survivors?FindingsIn this cross-sectional study of 72 adults, 40% demonstrated cognitive impairment, particularly in executive function.MeaningNeurologic sequelae, such as cognitive impairment, may be common following COVID-19 infection.

Post-acute COVID-19 cognitive impairment and decline uniquely associate with kynurenine pathway activation: a longitudinal observational study

“…The mild to moderate CI detected via the version of Cogstate battery used involves attention/working memory, psychomotor speed, and new learning. This type of cognitive deficit has been observed in other cognitive studies post mild to moderate COVID-19 7,8 . Mild to moderate CI can cause difficulties in cognitively demanding tasks and employment 44 , as shown in the current study.…”

“…The prevalence of clinically significant CI increased slightly across time (16% to 26%), albeit not to a statistically significant extent. Importantly, the severity of CI was within the mild and moderate deficit range and no patients progressed towards severe cognitive deterioration which is commensurate with what is expected from mild to moderate COVID in the sample’s age range 7, 8 . The detected pattern resembles the “brain fog” that has been widely reported by patients and is now recognized as a long-term consequence of COVID-19 infection 43 .…”

“…Severe cases (cases that require hospitalization) are at risk for both indirect and direct mechanisms of COVID-19 associated brain damage, particularly from hypoxia 5,6 , stroke, as well as the immune and inflammatory response to SARS-CoV-2 1 . Mild to moderate cases of COVID-19 (not requiring hospitalization) are still at risk of brain dysfunction, and cognitive deficits 7,8 . Such cases provide a window into the potential mechanisms of brain injury without the confounding role of severe disease and its complications [9][10][11] .…”

The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation

“…Cognitive problems may not be limited only to PwCOVID who are critically ill [ 13 ]. Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with cognitive impairments, especially in the domain of executive functioning, which can persist for some months, even in young individuals who did not require hospitalization [ 14 , 15 ]. While deficits in executive functions may not represent a serious clinical problem in young people, they could have implications in older people, since they are associated with an increased risk of falls [ 16 ].…”

Treatment experience of post-COVID cognitive impairment (clinical observation)

“…Спустя 2 года с начала пандемии COVID-19 объем знаний о влиянии вируса на нервную систему человека и когнитивные функции ограничен. Несмотря на то, что тяжесть персистирующих когнитивных симптомов часто связана с тяжестью инфекции острого периода, исследования показали, что когнитивные нарушения могут возникать у пациентов любого возраста с легкой формой COVID-19 [2][3][4][5]. На сегодняшний день отсутствует единая патогенетическая теория постковидных когнитивных нарушений, известны только отдельные патогенетические факторы, приводящие к ним: нейротропность и нейровирулентность SARS-CoV-2, системное воспаление, гипоксия и цереброваскулярные изменения.…”