Post-acute sequelae of COVID-19: Evidence of mood & cognitive impairment

Abstract

Acute health consequences associated with coronavirus disease 2019 (COVID-19) infection have been thoroughly characterized; however, long-term impacts are not yet understood. Post-acute sequelae of COVID-19 (PASC), also known as Long COVID syndrome, is the persistence of COVID-19 symptoms long after viral infection. In addition to physical symptoms, those with PASC experience changes in mental health, but few studies have empirically examined these effects. The current study investigated mood and cognitive functioning in individuals who have recovered from COVID-19 infection. We recruited 100 male and female adults (M=30 years old) with no history of mood or cognitive impairment prior to the COVID-19 pandemic (Jan. 2020). Half of the subjects were healthy controls (i.e., no prior COVID-19 infection) and half had received a past COVID-19 diagnosis (ascertained by PCR or antibody test) but were no longer infectious. Participants completed self-reported measures of stress, depression, and anhedonia, as well as the Attention Network Test (ANT), a behavioural measure of attentional alerting, orienting and executive functioning. Relative to controls, depression and anhedonia were significantly higher in the past-COVID group. Selective impairment in attention was observed in the past-COVID group, marked by deficits in executive functioning while alerting and orienting abilities remained intact. Effects were most pronounced among individuals diagnosed 1-4 months prior to assessment. There were no group differences in pandemic-related experiences with respect to social interaction, social distancing, or isolation. The past-COVID group scored significantly higher on perceived stress; however, this did not moderate any effects observed on mood or cognition. These findings implicate a protracted reaction to the virus, possibly via prolonged inflammation, contributing to sustained mood dysregulation and cognitive impairment. Future research should examine the neural and physiological underpinnings of PASC, particularly mechanisms that promote psychiatric sequelae 1 to 4 months following diagnosis.

‘I can’t cope with multiple inputs’: a qualitative study of the lived experience of ‘brain fog’ after COVID-19

“…4 7 9 19 A few studies have explored correlations between subjective cognitive dysfunction and neuropsychological testing deficits with mixed findings. [20][21][22] In this paper, we use patients' own descriptions of their symptoms (using their term 'brain fog') and, when appropriate, the US National Cancer Institute definition of 'neurocognitive symptoms' to describe subjective problems 'to do with the ability to think and reason, [including] the ability to concentrate, remember things, process information, learn, speak, and understand'. 23 Possible proposed biological factors include direct neuroinvasion, 24 viral persistence and chronic inflammation, 25 neuronal injury or toxicity and glial activation, 24 26 microvascular injury, 27 activation of autoimmune mechanisms 28 and Lewy body production, 29 while imaging demonstrates loss of grey matter in patients with COVID-19 in key brain regions.…”

Mental health and alcohol use among patients attending a post-COVID-19 follow-up clinic: a cohort study

“…Research estimates that that 20-30% of acute COVID-19 patients experience lasting psychiatric issues 2,16 although the wider literature on this topic reports a much broader range. Several psychiatric conditions have been reported in Long COVID populations including depression, anxiety, post-traumatic stress, fatigue, cognitive impairment, and sleep disturbance [16][17][18] . There is also inconsistency in the literature regarding typical symptom duration.…”

“…There is also inconsistency in the literature regarding typical symptom duration. Studies have indicated that psychiatric symptoms can last weeks to several months, and even up to a year and possibly beyond among severe acute COVID-19 patients 17,19 . It has also been said that persistent psychiatric sequelae gradually subside with the passing of time and so are unlikely to continue indefinitely 16 .…”

Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS

“…Whether this is directly related to the effects of the virus, effects of physical symptoms of long COVID or effects of the pandemic in general is not completely clear. However, recent studies in both adults and children suggest that mood and cognitive functioning after SARS-CoV-2 infection are impaired when compared to controls with similar pandemic-related experiences [ 31 , 32 ]. Changes in taste and smell including anosmia, ageusia, parosmia, and dysgeusia are reported with acute SARS-CoV-2 infection in children [ 20 ] and adults [ 33 ].…”