Short‐term neuropsychiatric outcomes and quality of life in COVID‐19 survivors

Abstract

Background The general medical impacts of coronavirus (COVID‐19) are increasingly appreciated. However, its impact on neurocognitive, psychiatric health and quality of life (QoL) in survivors after the acute phase is poorly understood. We aimed to evaluate neurocognitive function, psychiatric symptoms and QoL in COVID‐19 survivors shortly after hospital discharge. Methods This was a cross‐sectional analysis of a prospective study of hospitalized COVID‐19 survivors followed up for 2 months after discharge. A battery of standardized instruments evaluating neurocognitive function, psychiatric morbidity and QoL (mental and physical components) was administered by telephone. Results Of the 229 screened patients, 179 were included in the final analysis. Amongst survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory (11.8%), verbal fluency (34.6%) and working memory (executive function) (6.1%), respectively. Moreover, 58.7% of patients had neurocognitive impairment in at least one function. Rates of positive screening for anxiety, depression and post‐traumatic stress disorder were 29.6%, 26.8% and 25.1%, respectively. In addition, 39.1% of the patients had psychiatric morbidity. Low QoL for physical and mental components was detected in 44.1% and 39.1% of patients respectively. Delirium and psychiatric morbidity were associated with neurocognitive impairment, and female gender was related with psychiatric morbidity. Conclusion Hospitalized COVID‐19 survivors showed a considerable prevalence of neurocognitive impairment, psychiatric morbidity and poor QoL in the short term. It is uncertain if these impacts persist over the long term.

Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19

“…Among 9751 total participants, 5266 (54.0%) were male; 30 studies 9 , 10 , 11 , 12 , 13 , 15 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 34 , 35 , 36 , 37 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 51 , 52 reported mean or median ages younger than 60 years, and 14 studies 9 , 11 , 12 , 13 , 24 , 26 , 27 , 33 , 34 , 35 , 36 , 45 , 46 , 52 reported mean or median ages of 50 years or younger ( Table 1 ). Twenty-four studies 9 , 11 , 12 , 13 , 15 , 19 , 20 , 22 , 23 , 24 , 26 ,…”

“…Time zero definitions and lengths of follow-up varied substantially across studies, with very few studies using identical approaches to defining time zero, follow-up, and reporting. Time zero was defined as diagnosis or symptom onset in 16 studies, 10 , 11 , 22 , 24 , 27 , 31 , 33 , 35 , 37 , 39 , 40 , 41 , 45 , 47 , 48 , 50 hospital admission in 4 studies, 9 , 18 , 25 , 46 hospital discharge in 23 studies, 12 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 23 , 26 , 28 , 29 , 30 , 32 , 36 , 38 , 42 , 43 , 45 , 48 , 49 , 51 , 52 and recovery from acute illness in 4 studies. 8 , 13 , 34 , 44 Two studies used different time zero definitions for outpatients vs inpatients within the same study.…”

“…Fourteen studies 8 , 12 , 14 , 16 , 17 , 20 , 24 , 26 , 27 , 32 , 36 , 43 , 46 , 47 followed up all participants for a specified time. In the remaining studies, 9 , 10 , 11 , 13 , 15 , 18 , 19 , 21 , 22 , 23 , 25 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 48 , 49 , 50 , 51 , 52 the end of follow-up and the duration of symptoms were determined by the date of the last medical examination. Summary statistics also varied, with some studies 10 , 13 , 18 , 21 , 23 , 33 , 34 , 39 , 40 , 48 reporting the mean (SD) of follow-up time and ...…”

“…Data extracted included study and patient characteristics, selection criteria, length of follow-up, and outcome measurements ( Table 1 ). 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 We used 6 quality criteria based on the National Institutes of Health Quality Assessment Tool for Observational and Cohort Studies 53 to assess study design or features most likely to bias frequency estimates. Criteria comprised (1) prospective cohort (score range of 0-1, with 0 indicating no and 1 indicating yes), (2) representativeness (score range of 0-1, with 0 indicating sampling strategy unclear or nonconsecutive enrollees and 1 indicating patients were randomly selected or all eligible patients were included), (3) baseline severity of illness reported (score range of 0-1, with 0 indicating not reported and 1 indicating reported), (4) attrition (score range of 0-3, with 0 indicating not reported or attrition ≥30%, 1 indicating attrition of 20%-29%, 2 indicating attrition of 10%-19%, and 3 indicating attrition <10%), (5) repeated outcome measureme...…”

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

“…Additionally, a general cognitive decay, i.e., deficit in attention and calculation, short-term memory, constructional apraxia, and written language, was also observed during up to 6 months of follow-up ( 61 ). At 2 months of follow-up 58.7% of 179 mild-to-severe COVID-19 patients presented a moderate neurocognitive decline while 39.1% of patients also showed psychiatric morbidity ( 56 ). At a longer follow-up of 6 months, Pilotto et al, analyzing retrospectively 165 moderate-to-severe COVID-19 patients, showed that these long-term symptoms persisted in about 37% of patients ( 61 ).…”