Post-COVID cognitive deficits at one year are global and associated with elevated brain injury markers and grey matter volume reduction: national prospective study

Abstract

The spectrum, pathophysiology, and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the one-year cognitive, serum biomarker, and neuroimaging findings from a prospective, national longitudinal study of cognition in 351 COVID-19 patients who had required hospitalisation, compared to 2,927 normative matched controls. Cognitive deficits were global and associated with elevated brain injury markers and reduced anterior cingulate cortex volume one year after admission. The severity of the initial infective insult, post-acute psychiatric symptoms, and a history of encephalopathy were associated with greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Treatment with corticosteroids during the acute phase appeared protective against cognitive deficits. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 is immune-mediated, and should guide the development of therapeutic strategies.

Patients Recovering from COVID-19 who Presented Anosmia During their Acute Episode have Behavioral, Functional, and Structural Brain Alterations

“…Most of the research that has identified manifest cognitive deficits typically involves more severe respiratory cases of COVID-19 [50][51][52] or those who present neurological symptoms during the acute episode. 9 Additionally, these patterns of results are more likely to be found when focusing on a subset of the population that likely represents a more susceptible group, such as those individuals who report subjective cognitive symptoms persisting for more than a month after infection. 9 A study using web-based assessments over a large sample of subjects found that individuals recovering from COVID-19 exhibited alterations in cognitive tests, with more pronounced effects observed in those who were hospitalized.…”

“…9 Additionally, these patterns of results are more likely to be found when focusing on a subset of the population that likely represents a more susceptible group, such as those individuals who report subjective cognitive symptoms persisting for more than a month after infection. 9 A study using web-based assessments over a large sample of subjects found that individuals recovering from COVID-19 exhibited alterations in cognitive tests, with more pronounced effects observed in those who were hospitalized. 53 However, significant alterations were also evident in those who did not require hospitalization.…”

“…8 Furthermore, patients who experienced a severe episode and exhibited neurological symptoms during the infection displayed cognitive impairment and brain alterations one-year post-infection. 9 Moreover, even patients with mild COVID-19 also present subtle brain alterations. [1][2][3] It remains unknown which risk factors or clinical profiles distinguish mild COVID-19 patients who may present this alteration from those who do not.…”

Navigating the Evolving Landscape of COVID-19: Strategies to Increase Vaccine Confidence and Improve Vaccination Rates in the United States

“…[22] One study found the cognitive deficits associated with long COVID in those hospitalized for COVID-19 were equivalent in magnitude to 20 years of aging. [27] It is estimated that close to 1 in 4 American adults who currently have long COVID have significant activity limitations. [22] COVID-19 Burden vs.…”