Mild Cognitive Disorder in Post-COVID-19 Syndrome: A Retrospective Cohort Study of 67,000 Primary Care Post-COVID Patients

Abstract

Background: Little is known about the impact of COVID-19 on mild cognitive disorder. Objective: The aim of this retrospective cohort study was to investigate whether COVID-19 diagnosis is associated with subsequent mild cognitive disorder (MCD) compared to acute upper respiratory infections (AURI). Methods: This retrospective cohort study used data from the Disease Analyzer database (IQVIA) and included 67,046 patients with first-time symptomatic or asymptomatic COVID-19 diagnoses in 1,172 general practices in Germany between March 2020 and September 2021. Diagnoses were based on ICD-10 codes. Patients diagnosed with AURI were matched to 67,046 patients with COVID-19 using propensity scores based on sex, age, index month, and comorbidities. The index date was the diagnosis date for either COVID-19 or AURI. Associations between the COVID-19 and MCD were studied using conditional Poisson regression models. Results: The incidence of MCD was 7.6 cases per 1,000 person-years in the COVID-19 group and 5.1 cases per 1,000 person-years in the AURI group (IRR = 1.49, 95% CI = 1.22–1.82). The incidence rate ratio decreased strongly with increasing age from 10.08 (95% CI = 4.00–24.42) in the age group≤50 to 1.03 (95% CI = 0.81–1.31) in the age group > 70. In addition, the association between COVID-19 and MCD was significant in women (IRR: 1.70, 95% CI: 1.34–2.16) but not in men (IRR: 1.08, 95% CI: 0.75–1.56). Conclusion The incidence of MCD was low but significantly higher in COVID-19 than in AURI patients, especially among younger patients. If a cognitive disorder is suspected, referral to a specialist is recommended.

Associations between SARS-CoV-2 infection and incidence of new chronic condition diagnoses: a systematic review

“… Study Country Data source Index time for SARS-CoV-2 infections Study design N Mean/ median follow-up, range If not reported, maximum range of FU? Care type/setting for SARS-CoV-2 infected cases Age range (years) % Female % Hospitalized % in ICU Comparator timing Test status of comparator group Outcomes Abel 2021 [ 32 ] United Kingdom Clinical Practice Research Datalink Aurum Feb 2020 to Dec 2020 Retrospective cohort N = 11,923,105 Median (IQR) – 6.3 (4.0–9.3) weeks Outpatient 16–80+ 50% NA Concurrent No confirmed/ suspected SARS-CoV-2 infection Mental disorders (anxiety disorders, depression, psychosis) Ayoubkhani 2021 [ 33 ] United Kingdom Hospital Episode Statistics Admitted Patient Care and General Practice Extraction Service Data for Pandemic Planning and Research Jan 2020 to Aug 2020 Retrospective cohort N = 95,560 Cov: Mean (SD) – 140 (50) days Con: Mean (SD) – 153 (33) days Inpatient 0–70 + 45% 100 NR Concurrent No confirmed/ suspected SARS-CoV-2 infection Cardiovascular disease (composite of arrhythmia, heart failure, myocardial infarction, and stroke); Chronic kidney disease (dialysis and kidney transplant); Diabetes (type 1 & type 2); Respiratory disorders Bohlken 2022 [ 34 ] Germany IQVIA Disease Analyzer database Mar 2020 to Sept 2021 Retrospective cohort N = 134,092 Cov: Mean – 158 days Con: Mean – 165 days Outpatient 18–70+ 53.3% NA Concurrent >90% had test negative Neurological conditions (mild cognitive disorder) …”

Assessment and Characterization of Covid-19 Related Cognitive Decline: Results From a Natural Experiment

“…Patients with severe COVID-19 have been found to have transcriptomic changes in their prefrontal cortex like those of older individuals, [28] and severe COVID-19 yielded a drop in global cognitive performance consistent with decline usually spread over 10 years of normal aging, [29] consistent with the results of our study. According to a large cohort study in a primary care setting, when compared to patients with the diagnosis of acute upper respiratory tract infections (AURI), individuals with the diagnosis of COVID-19 had a significantly higher incidence of mild cognitive disorder (7.6 COVID-19 cases/1,000 person-years vs. 5.1 AURI cases/1,000 person-years), but a lower overall incidence [30] indicating that COVID-19 diagnosed outside of general practice may be misclassified as AURI. This limitation may lower the incidence of COVID-19-related MCI.…”

Demenz-Screening- und testpsychologische Untersuchungen in deutschen Haus- und Facharztpraxen unter Bedingungen der Corona Pandemie

“…Erste Hinweise gibt es auch, wie sich die Rahmenbedingungen von hausärztlicher Tätigkeit in Heimen strukturell geändert haben und Folgen für die Patientenversorung aufweisen [14]. In einer eigenen Studie konnten wir zeigen, dass die kognitiven Störungen im Rahmen einer COVID-19-Erkrankung zunahmen, aber dass dies im Praxisalltag ein sehr seltenes Ereignis darstellte [15].…”