Neurocognitive and Psychosocial Characteristics of Pediatric Patients With Post-Acute/Long-COVID: A Retrospective Clinical Case Series

Abstract

Objective Studies suggest a large number of patients have persistent symptoms following COVID-19 infection—a condition termed “long COVID.” Although children and parents often report cognitive difficulties after COVID, very few if any studies have been published including neuropsychological testing. Methods A retrospective chart review was completed for the first 18 patients referred for a neuropsychological evaluation from a multidisciplinary pediatric post-COVID clinic. The neuropsychological screening battery assessed verbal fluency and category switching, attention, working memory, processing speed, and verbal learning and memory. Patients’ caregivers also completed standardized questionnaires regarding day-to-day mood and behavior. Results At intake, the most common neurologic symptoms reported by caregivers were attention problems (83.3%), fatigue/lethargy (77.7%), sleep disturbance (77.7%), dizziness/vertigo (72.2%), and headaches (72.2%). On rating scales, most caregivers endorsed concerns for depressed mood and anxiety (14/15 and 12/15). A large proportion of patients had difficulties with attention (9/18) and depressed mood/anxiety (13/18) before COVID. On cognitive testing, the majority of the patients performed within or above broad average range (≥16th percentile) across most domains. However, a little over half of the patients performed below average on auditory attention measures. Conclusions Within our clinically referred sample, children who reported lingering cognitive symptoms after COVID-19 often had a preexisting history of attention and/or mood and anxiety concerns. Many of these patients performed below average in attention testing, but it remains to be seen whether this was due to direct effects of COVID, physical symptoms, and/or preexisting difficulties with attention or mood/anxiety.

Cognition and Mental Health in Pediatric Patients Following COVID-19

“…Nearly 18% of the patients were found to have memory impairment [ 14 ]. Research involving a retrospective chart review of 18 children aged 6-16 years found that 22.2% had memory difficulties [ 15 ]. While not one of the most common cognitive symptoms in children, overall studies show that the clinical manifestation of long COVID is similar in both adult and child populations [ 16 ].…”

“…It was estimated that 45% of the patients experienced concentration problems [ 21 ]. A neuropsychological test conducted on 18 patients aged 6 to 16 reported that 83% suffered from attention problems [ 15 ]. A cross-sectional study including children under 18 years diagnosed with COVID-19 found that at least 10% of the patients suffered from a lack of concentration for more than three months after the diagnosis of COVID-19 [ 22 ].…”

“…According to Zimmermann et al, sleep disturbances occurred in 2-63% of long COVID pediatric patients [ 10 ]. A retrospective clinical case series in long COVID pediatric patients reported persistent sleep disturbances in 77.7% of the patients [ 15 ]. A study designed to identify long COVID syndrome in children found that sleep disturbances were the most prevalent symptom (18.6%) when assessed at least 60 days after SARS-CoV-2 positive diagnosis [ 22 ].…”

Persistent symptoms are associated with long term effects of COVID-19 among children and young people: Results from a systematic review and meta-analysis of controlled studies

“…20 of the 55 studies included population-based control groups [ 10 , 11 , 19 , 20 , 23 , 24 , 26 , 29 , 33 , 35 , 36 , 38 , 39 , 46 , 47 , 53 , 60 – 63 , 65 ]. 18 (33%) recruited from a mix of previously hospitalised and non-hospitalised [ 11 , 23 , 26 , 31 , 32 , 35 , 36 , 40 , 41 , 48 , 49 , 51 , 53 , 58 , 61 , 65 , 67 , 71 ], 27 (49%) recruited from non-hospitalised CYP [ 10 , 12 , 19 , 20 , 24 , 27 – 29 , 33 , 37 , 38 , 45 – 47 , 52 , 54 – 57 , 59 , 60 , 62 , 63 ,…”

“…Two of the studies used the same population and methodology but presented findings in two publications divided by age group [19,20]. These two publications were Of the 55 included studies, 35 (64%) were cohort studies [10][11][12], 14 (25%) crosssectional studies [19,20,[54][55][56][57][58][59][60][61][62][63][64][65][66], and 6 (11%) were case reports or series [67][68][69][70][71][72]. 20 of the 55 studies included population-based control groups [10,11,19,20,23,24,26,29,33,35,36,38,39,46,47,53,[60][61][62][63]65].…”