Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19

Abstract

Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation. Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.

Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation

“…All data were extracted from retrospective chart reviews under approval of the Weill Cornell Medicine Institutional Review Board. 19/77 patients underwent a separate neuropsychological evaluation during their admission, the results of which have been published 5 ; the results described here are novel.…”

“…Among community-dwelling patients with mild cases of COVID-19, 21% of patients experienced a decline in cognitive functioning 4 . 81% of hospitalized but post-acute COVID-19 patients score abnormally on neuropsychological measures of attention, processing speed, and executive function 5 . There is still limited knowledge on how cognitive deficits evolve and impact functional outcome.…”

Cognitive impairment in COVID-19 survivors

“…По данным одного из последних метаанализов, в общей сложности выявлено 55 симптомов, сохраняющихся у лиц после перенесенной острой коронавирусной инфекции. Пятью наиболее частыми проявлениями были утомляемость (58%, 95% ДИ: 42-73), головная боль (44%, 95% ДИ: 13-78), нарушение внимания (27%, 95% ДИ: [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], выпадение волос (25%, 95% ДИ: 17-34) и одышка (24%, 95% ДИ: 14-36) [12].…”

“…Наиболее частым клиническим проявлением COVID-19 является развитие острого респираторного дистресссиндрома (ОРДС) [20], что наряду с нарушенной дыхательной функцией легких тесно связано с последующим снижением когнитивных функций, качества жизни и часто может сохраняться месяцы и годы после выписки из больницы [21,22]. У большинства пациентов с тяжелым ОРДС, ключевым признаком тяжелого заболевания COVID-19, в течение 1 года наблюдаются нарушения памяти, внимания, концентрации или скорости мыслительных процессов [23].…”

The impact of COVID-19 on cognition in severe cases highlights the need for comprehensive neuropsychological evaluations in all survivors

“…The study by Jaywant et al [1] in this issue is an early characterization of the potential for longer-term consequences of the COVID-19 pandemic on brain function. This manuscript reports on an observational (cross-sectional) study investigating the relationship between COVID infection/hospitalization and cognitive outcomes in 57 hospitalized participants recovering from COVID-19 in rehabilitation units in New York City.…”