Perceived Cognitive Deficits in Patients With Symptomatic SARS-CoV-2 and Their Association With Post–COVID-19 Condition

Abstract

ImportanceNeuropsychiatric symptoms are common in acute SARS-CoV-2 infection and in post–COVID-19 condition (PCC; colloquially known as long COVID), but the association between early presenting neuropsychiatric symptoms and PCC is unknown.ObjectiveTo describe the characteristics of patients with perceived cognitive deficits within the first 4 weeks of SARS-CoV-2 infection and the association of those deficits with PCC symptoms.Design, Setting, and ParticipantsThis prospective cohort study was conducted from April 2020 to February 2021, with follow-up of 60 to 90 days. The cohort consisted of adults enrolled in the University of California, Los Angeles, SARS-CoV-2 Ambulatory Program who had a laboratory-confirmed symptomatic SARS-CoV-2 infection and were either hospitalized in a University of California, Los Angeles, hospital or one of 20 local health care facilities, or were outpatients referred by a primary care clinician. Data analysis was performed from March 2022 to February 2023.ExposureLaboratory-confirmed SARS-CoV-2 infection.Main Outcomes and MeasuresPatients responded to surveys that included questions about perceived cognitive deficits modified from the Perceived Deficits Questionnaire, Fifth Edition, (ie, trouble being organized, trouble concentrating, and forgetfulness) and symptoms of PCC at 30, 60, and 90 days after hospital discharge or initial laboratory-confirmed infection of SARS-CoV-2. Perceived cognitive deficits were scored on a scale from 0 to 4. Development of PCC was determined by patient self-report of persistent symptoms 60 or 90 days after initial SARS-CoV-2 infection or hospital discharge.ResultsOf 1296 patients enrolled in the program, 766 (59.1%) (mean [SD] age, 60.0 [16.7] years; 399 men [52.1%]; 317 Hispanic/Latinx patients [41.4%]) completed the perceived cognitive deficit items at 30 days after hospital discharge or outpatient diagnosis. Of the 766 patients, 276 (36.1%) perceived a cognitive deficit, with 164 (21.4%) having a mean score of greater than 0 to 1.5 and 112 patients (14.6 %) having a mean score greater than 1.5. Prior cognitive difficulties (odds ratio [OR], 1.46; 95% CI, 1.16-1.83) and diagnosis of depressive disorder (OR, 1.51; 95% CI, 1.23-1.86) were associated with report of a perceived cognitive deficit. Patients reporting perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection were more likely to report symptoms of PCC than those without perceived cognitive deficits (118 of 276 patients [42.8%] vs 105 of 490 patients [21.4%]; χ21, 38.9; P < .001). Adjusting for demographic and clinical factors, perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 were associated with PCC symptoms (patients with a cognitive deficit score of >0 to 1.5: OR, 2.42; 95% CI, 1.62-3.60; patients with cognitive deficit score >1.5: OR, 2.97; 95% CI, 1.86-4.75) compared to patients who reported no perceived cognitive deficits.Conclusions and RelevanceThese findings suggest that patient-reported perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection are associated with PCC symptoms and that there may be an affective component to PCC in some patients. The underlying reasons for PCC merit additional exploration.

Objective and subjective cognitive status after intensive care unit treatment for COVID-19

“…For example, the correlations between self-reports and performance-based cognitive measures tend to be weak to moderate in patients with depression, who often report more subjective cognitive complaints than what is revealed in performance-based measures ( Serra-Blasco et al, 2019 ; Douglas et al, 2018 ). Our exploratory analyses identified an association between symptoms of depression and posttraumatic stress and subjective cognitive complaints, supporting previous findings regarding COVID-19 patients ( Zlatar et al, 2017 ; Liu et al, 2023 ). Furthermore, depressive symptoms were found to be associated with scoring below the Mini-MoCA cut-off at six months.…”

Neurofilament light chain and glial fibrillary acid protein levels are elevated in post-mild COVID-19 or asymptomatic SARS-CoV-2 cases

“…The second relevant finding of our study is represented by the higher sNfL and sGFAP levels in the eleven COVID-19 patients complaining of cognitive failures at T0. Cognitive deficits are common after COVID-19 and can impair executive functions, attention, and episodic memory 40 , 41 , 43 , 44 . Studies on the neuropsychological alterations during acute COVID-19 and in the post-COVID-19 phase show inhomogeneous results, particularly for the variable time of the evaluation, ranging from two to five weeks after the onset, up to one year after the recovery 42 , 43 , 45 , 46 .…”

“…Cognitive deficits are common after COVID-19 and can impair executive functions, attention, and episodic memory 40 , 41 , 43 , 44 . Studies on the neuropsychological alterations during acute COVID-19 and in the post-COVID-19 phase show inhomogeneous results, particularly for the variable time of the evaluation, ranging from two to five weeks after the onset, up to one year after the recovery 42 , 43 , 45 , 46 . Most of these studies, however, mainly focus on hospitalized patients, being non-hospitalised patients somehow overlooked.…”

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

“…216 Liu et al found that perception of (subjective) cognitive deficit during acute COVID-19 was associated with later Long-COVID, suggesting "an affective component to Post-COVID-19-condition in some patients." 217 Haddad et al found that "the number of moderate or severe persistent symptoms reported by individuals (in both an exposed uninfected group and an infected group) was associated with the number of moderate or severe persistent symptoms reported by their household members [i.e., prolonged symptoms tended to cluster within families]," and that "parents who reported their own health status at T1 was worse or much worse than before the pandemic were around 3-times more likely to report that their child had symptoms that persisted until T2." 23 The authors noted that in several other conditions, including chronic pain, CFS, and fatigue, "symptom measures in children are associated with parents' symptoms, stress, and/or parenting behavior."…”