Neuropsychological manifestations of long COVID in hospitalized and non-hospitalized Brazilian Patients

Abstract

BACKGROUND: There has been a significant increase in number of patients seeking neuropsychological rehabilitation months after the acute phase of COVID-19 infection. OBJECTIVE: Identify the cognitive and psychiatric disorders in patients with long COVID or Post-Acute Sequelae of COVID (PASC) and explore the association between disease severity during the acute phase and persistent neuropsychological manifestations. METHODS: 614 adults were assessed an average of eight months post-infection. Participants were, on average, 47.6 y.o., who sought rehabilitation for neuropsychological problems. Patients were evaluated using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing tests (NEUPSILIN) for executive functions, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The BNIS score was significantly below reference values in all subscales, especially affect and memory. Verbal Fluency and Clock Drawing subtest results were also lower. Patients with PASC tested high for anxiety/depression, but there was no statistically significant relationship between HADS and BNIS scores. Neuropsychological evaluations showed no differences in cognitive or psychiatric profiles between hospitalized and non-hospitalized patients. CONCLUSIONS: Neuropsychological results suggest executive function problems and high incidence of anxiety/depression, irrespective of acute-phase severity, underscoring a need for neurorehabilitation programs while providing data for public policy initiatives.

Twelve-month follow-up after hospitalization for SARS-COV-2: Physiology improves, symptoms remain

“…Anxiety and depression at 12 months were independent of WCP categories which is similar to findings by Braga et al [35] . Still, the reason for the lack of improvement in fatigue, anxiety, and depression measured by PROMs and other self-reported symptoms are not fully understood, but pre-COVID comorbidity may play a role.…”

Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach

“…Recent literature regarding the long-term neuropsychiatric sequelae of COVID-19 focused on self-reported symptoms through questionnaires administered either in-person or by telephone interviews [ 52 , 53 , 54 ]. Notably, Long COVID has been found to cause anxiety and depression symptoms as well as other neuropsychiatric and cognitive sequelae [ 55 , 56 , 57 , 58 , 59 ]. Indeed, the incidence of anxiety, depression, and post-traumatic stress was 42%, 31%, and 28%, respectively, in an Italian sample [ 60 ].…”

Neurological Consequences, Mental Health, Physical Care, and Appropriate Nutrition in Long-COVID-19

“…Most frequently reported neurological diagnoses during the acute COVID-19 infection include ischemic and hemorrhagic stroke, delirium/encephalopathy, seizures, neuropathy, and myopathy. Persistent neurologic symptoms have been described in long-COVID subjects, who often described cognitive impairment/brain fog, headache, sensory symptoms, myalgias (Nolen et al 2022 ), and verbal fluency deficit (Braga et al 2022 ).…”

“…It has been done the hypothesis that the brain invasion through the indirect way starts at the level of the ACE2 receptors present in the lung epithelium from which the virus enters the bloodstream, infects the blood–brain barrier and spreads into the brain (Li et al 2020 ). Once entered the CNS, because of the diffuse presence of ACE2 receptors, SARS-CoV-2 can cause disruption of the normal brain homeostasis (Braga et al 2022 ), mitochondrial dysfunction, microglia activation, persistent neuroinflammation, and protein misfolding and aggregation leading to cell death (Song et al 2021 ). It is interesting to observe that these injuries are shared with some neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), optic neuritis and multiple sclerosis.…”

“…The authors, however, caution against considering these results as general because they were obtained in predominantly male, young people, and members of the British armed forces. Braga et al found a high incidence of neuropsychological problems among female vs male in a sample of 614 adults (Braga et al 2022 ). The prolonged confinement due to the COVID-19 lockdown, has had a deleterious impact particularly on the mental health of young people up to 20 years old, particularly if disadvantaged (Creswell et al 2021 ).…”