Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment

Abstract

Background Cognitive manifestations associated with the severity of a novel coronavirus (COVID-19) infection are unknown. An early detection of neuropsychological manifestations could modify the risk of subsequent irreversible impairment and further neurocognitive decline. Methods In our single-center cohort study, we included all consecutive adult patients, aged between 20 and 60 years old with confirmed COVID-19 infection. Neuropsychological assessment was performed by the same trained neuropsychologist from April, 22nd through June 16th, 2020. Patients with previous known cognitive impairment, any central nervous system or psychiatric disease were excluded. Demographic, clinical, pharmacological and laboratory data were extracted from medical records. Results Thirty-five patients met inclusion criteria and were included in the study. Patients presenting headache, anosmia, dysgeusia, diarrhea and those who required oxygen therapy had lower scores in memory, attention and executive function subtests as compared to asymptomatic patients. Patients with headache and clinical hypoxia scored lower in the global Cognitive Index (P ​= ​0.002, P ​= ​0.010). A T score lower than 30 was observed in memory domains, attention and semantic fluency (2 [5.7%]) in working memory and mental flexibility (3 [8.6%]) and in phonetic fluency (4 [11.4%]). Higher scores in anxiety and depression (P ​= ​0.047, P ​= ​0.008) were found in patients with cognitive complaints. Conclusions In our cohort of COVID-19 patients neurologic manifestations were frequent, including cognitive impairment. Neurological symptoms during infection, diarrhea and oxygen therapy were risk factors for neurocognitive impairment. Cognitive complaints were associated with anxiety and depression.

Brain Metabolic Correlates of Persistent Olfactory Dysfunction after SARS-Cov2 Infection

“…Thus, our findings largely confirm the topography of brain hypometabolism in patients in long COVID patients although associated with persistent hyposmia or with other persistent functional complaints [ 26 ]. The presence and the topography of hypometabolism after recovery in all the mentioned case reports, in previous small group studies and in our hyposmic group repetitively highlighted an involvement of limbic regions and might point to the risk of developing long-term neurological (possibly cognitive) sequelae, a hypothesis requiring studies in patients with a much longer recovery from infection [ 8 , 27 , 28 ]. Indeed, olfactory cortical area feeds into multimodal integration relevant for cognition control and the hippocampal regions is known to exchange input for storage of olfactory memory (also relevant for working memory [ 29 ]).…”

“…Indeed, olfactory cortical area feeds into multimodal integration relevant for cognition control and the hippocampal regions is known to exchange input for storage of olfactory memory (also relevant for working memory [ 29 ]). Almeria et al evaluated the impact of COVID-19 on neurocognitive performance in thirty-five patients with confirmed COVID-19 infection and found that the presence of anosmia and dysgeusia at the time of infection were among the main risk factors for cognitive impairment related with attention, memory and executive function [ 28 ].…”

Neuropsychiatrische Folgen der COVID-19-Pandemie

“…Spezifische Defizite im Rahmen einer ausführlichen neuropsychologischen Testung wurden kürzlich im Bereich der Aufmerksamkeits-und Merkfähigkeitsstörungen sowie Störungen der exekutiven Funktionen bei Patienten mit nachgewiesener COVID-19-Infektion ca. einen Monat nach der Infektion beschrieben [36]. Ähnliche Ergebnisse liefert auch eine große populationsbasierte Studie mit 84285 Patienten aus Großbritannien [37].…”

Long COVID neuropsychological deficits after severe, moderate or mild infection

“…Fourth , to our knowledge only one study has so far explored the short-term impact (10-40 days post-hospital discharge) of SARS-CoV-2 infection on cognition using a validated and standardized methodology with face-to-face interviews (Almeria, Cejudo, Sotoca, Deus, & Krupinski, 2020). These authors reported short-term disruption of memory, attention, and executive functions.…”

“…They reported memory and attentional deficits in patients compared with matched controls. These approaches had several potential methodological issues, such as the use of an online survey relying on participants’ unverified self-reports (Hampshire et al, 2020), and the failure to collect information about patients’ clinical history or medical antecedents (Almeria et al, 2020; Woo et al, 2020), which may have induced interindividual variability in the results. Moreover, no study has investigated the long-term effects of infection on the instrumental domains (including visuospatial processing, ideomotor praxis, and language) or emotion recognition.…”