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S N, Kp L, Menon B. Cognitive impairment in patients with history of severe COVID. Asian J Psychiatr 2024; 100:104163. [PMID: 39083956 DOI: 10.1016/j.ajp.2024.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Neethu S
- Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Kochi, India.
| | - Lakshmi Kp
- Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Kochi, India.
| | - Bindu Menon
- Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Kochi, India.
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Lee D, Hyun SY, Kim H, Kwak E, Lee S, Baik M, Paik JW, Sim M, Jung SJ. Comparative analysis of mental health impairment among COVID-19 confirmed cases across the pandemic period in South Korea. Asian J Psychiatr 2024; 101:104233. [PMID: 39265382 DOI: 10.1016/j.ajp.2024.104233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVES South Korea operates a complete enumeration surveillance of coronavirus disease 2019 (COVID-19). Online mental health survey links were distributed to all COVID-19 confirmed patients within three days of confirmation of infection. This study evaluates the trend of depressive symptoms, anxiety symptoms, post-traumatic stress symptoms, somatic symptoms, and suicidal ideation of COVID-19 confirmed cases across the pandemic from January 2020 to July 2022. METHODS A total of 99,055 responses were analyzed. Validated questionnaires were used to assess depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), post-traumatic stress symptoms (Primary Care Post Traumatic Stress Disorder screen), somatic symptoms (Patient Health Questionnaire-15), and suicidal ideation (P4 suicidality screener). Log-binomial regression was used to estimate prevalence ratio across 11 quarters (Q) of the year (2020Q1 to 2022Q3). Stratified analysis was conducted by sex to compare risk between males and females when adjusted prevalence was high. RESULTS Compared to 2022Q1 (January-March), all symptoms had their highest prevalence ratio during 2020Q1 to 2020Q3 (January-September). The difference in adjusted symptom prevalence between males and females was nonsignificant during high-risk periods. CONCLUSIONS Adverse mental health symptoms were most prevalent during the early pandemic, with a nonsignificant difference in prevalence observed between males and females. Greater attention should be given to individuals who experienced COVID-19 infection during the early stages of the pandemic.
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Affiliation(s)
- Dongkyu Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Hyun
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea
| | - Hyejin Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Euihyun Kwak
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea
| | - Songeun Lee
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea
| | - Myungjae Baik
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Minyoung Sim
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea.
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea; Broad institute of MIT and Harvard, Boston, MA, USA.
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Koterba CH, Considine CM, Becker JH, Hoskinson KR, Ng R, Vargas G, Basso MR, Puente AE, Lippa SM, Whiteside DM. Neuropsychology practice guidance for the neuropsychiatric aspects of Long COVID. Clin Neuropsychol 2024:1-29. [PMID: 39177216 DOI: 10.1080/13854046.2024.2392943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
Objective: The coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has had a profound global impact on individual health and well-being in adults and children. While most fully recover from COVID-19, a relatively large subgroup continues to experience persistent physical, cognitive, and emotional/behavioral symptoms beyond the initial infection period. The World Health Organization has termed this phenomenon "Post-COVID-19 Condition" (PCC), better known as "Long COVID." Due to the cognitive and psychosocial symptoms, neuropsychologists often assess and recommend treatment for individuals with Long COVID. However, guidance for neuropsychologists' involvement in clinical care, policy-making, and research has not yet been developed. The authors of this manuscript convened to address this critical gap and develop guidance for clinical neuropsychologists working with patients presenting with Long COVID. Method: Authors include pediatric and adult neuropsychologists with expertise in Long COVID and behavioral health. All authors have been engaged in clinical and research efforts examining the impact of COVID-19. Authors summarized the literature-to-date pertinent to the neuropsychiatric sequelae of Long COVID and developed guidance for neuropsychologists working with individuals with Long COVID. Conclusions: Research findings regarding neuropsychiatric symptoms associated with Long COVID are mixed and limited by methodological differences. As they practice and conduct research, neuropsychologists should remain mindful of the evolving and tenuous nature of the literature.
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Affiliation(s)
- Christine H Koterba
- Department of Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ciaran M Considine
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacqueline H Becker
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen R Hoskinson
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gray Vargas
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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Chakrabarty M, Chatterjee P, Mukherjee A, Das G, Mollah RI, Mondal B, Sardar S, Basu A, Ghosh M, Sengupta A, Pal SK, Biswas A. Mental health problems raise the odds of cognitive impairment in COVID-19 survivors. Front Psychiatry 2024; 15:1370085. [PMID: 39205850 PMCID: PMC11349739 DOI: 10.3389/fpsyt.2024.1370085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024] Open
Abstract
Background COVID-19 survivors around the globe are suffering from mental health issues. While mental health problems can be an early warning sign of dementia, they may also increase the chances of developing the disease. In this study, we examined the mental health of COVID-19 survivors and mapped its associations with cognitive and demographic variables. Method COVID-19 survivors listed in the databases of three tertiary care hospitals in Kolkata were contacted sequentially. 376 willing patients were interviewed over the telephone. 99 COVID-19 patients and 31 matched controls participated in the in-person interviews that were arranged for a more detailed investigation. The participants were administered standardized tests that are widely used for the assessment of cognitive functioning and mental health status. Result 64.89% of COVID-19 survivors reported a deterioration in physical functioning. 44.95% reported a decline in mental health, whereas 41.49% reported a drop in cognitive performance. Detailed investigations revealed that they had an increased risk of having depression, anxiety, and poor sleep quality by 91%, 68%, and 140%, respectively. 6.1% of the patients had mild cognitive impairment, and 4% had dementia. COVID-19 patients who had depression and anxiety were 8.6 and 19.4 times more likely to have cognitive decline, respectively. Compared to the matched controls, COVID-19 patients had greater depression (p<.001), anxiety (p<.001), stress (p =.003), and insomnia (p <.001). They also scored significantly lower on Addenbrooke's Cognitive Examination-III (p =.009) and Picture Naming Test (p =.005) and took significantly longer to complete Trail Making Test-A (p =.002). Conclusion COVID-19 survivors in this study had major mental health issues even one year after contracting the virus. They had significant cognitive deficits that might progress into dementia. Strict monitoring and systematic treatment plans should be implemented as soon as possible.
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Affiliation(s)
- Madhushree Chakrabarty
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Piali Chatterjee
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Adreesh Mukherjee
- Department of Neuromedicine, North Bengal Medical College, Siliguri, India
| | - Gautam Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Rafikul Islam Mollah
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Banshidhar Mondal
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Swarup Sardar
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Ayanendranath Basu
- Interdisciplinary Statistical Research Unit (ISRU), Indian Statistical Institute, Kolkata, India
| | | | - Amitabha Sengupta
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
| | - Sankar K. Pal
- Center for Soft Computing Research, A National Facility (CSCR), Indian Statistical Institute, Kolkata, India
| | - Atanu Biswas
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
- Department of Neuromedicine, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
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Charoenporn V, Tungsukruthai P, Teacharushatakit P, Hanvivattanakul S, Sriyakul K, Sukprasert S, Kamalashiran C, Tungsukruthai S, Charernboon T. Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: A randomized controlled trial. Psychiatry Clin Neurosci 2024. [PMID: 39072958 DOI: 10.1111/pcn.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
AIM This study evaluated the effectiveness of high-dose vitamin D supplementation in alleviating fatigue and neuropsychiatric symptoms in post-COVID syndrome. METHODS In an 8-week, double-blind, randomized, placebo-controlled trial, 80 patients with post-COVID fatigue or neuropsychiatric symptoms were enrolled. Participants were randomly assigned to receive either 60,000 IU of vitamin D weekly (n = 40) or a placebo (n = 40) for 8 weeks. Clinical outcomes were assessed using the 11-item Chalder Fatigue Scale (CFQ-11); 21-item Depression, Anxiety, and Stress Scale (DASS-21); Pittsburgh Sleep Quality Index (PSQI); Addenbrooke's Cognitive Examination III (ACE); and Trail Making Test A and B (TMT-A and TMT-B). Baseline and 8-week measurements of inflammatory markers, including interleukin 6 (IL-6) and C-reactive protein (CRP), were also collected. RESULTS Significant improvements were found in the vitamin D group for CFQ (coefficient -3.5, P = 0.024), DASS-anxiety (-2.0, P = 0.011), and ACE (2.1, P = 0.012). No significant differences were observed in PSQI, DASS-depression, TMT, IL-6, or CRP levels. The incidence of adverse events was comparable between groups, with no serious adverse events reported. CONCLUSION High-dose vitamin D supplementation may benefit patients with post-COVID syndrome by reducing fatigue, alleviating anxiety, and improving cognitive symptoms, with minimal side effects.
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Affiliation(s)
- Veevarin Charoenporn
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Department of Psychiatry, Thammasat University Hospital, Pathumthani, Thailand
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Parunkul Tungsukruthai
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Kusuma Sriyakul
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sophida Sukprasert
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chuntida Kamalashiran
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sucharat Tungsukruthai
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Thammanard Charernboon
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
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Panagea E, Messinis L, Petri MC, Liampas I, Anyfantis E, Nasios G, Patrikelis P, Kosmidis M. Neurocognitive Impairment in Long COVID: A Systematic Review. Arch Clin Neuropsychol 2024:acae042. [PMID: 38850628 DOI: 10.1093/arclin/acae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory infectious disease, it has also been associated with a wide range of other clinical manifestations. It is widely accepted in the scientific community that many patients after recovery continue to experience COVID-19-related symptoms, including cognitive impairment. The aim of this systematic review was to investigate the cognitive profile of patients with long-COVID syndrome. METHODS A systematic search of empirical studies was conducted through the PubMed/Medline and Scopus electronic databases. Cross-sectional and longitudinal studies published between 2020 and 2023 were included. RESULTS Of the 516 studies assessed for eligibility, 36 studies met the inclusion criteria. All included studies support the presence of persistent cognitive changes after COVID-19 disease. Executive function, memory, attention, and processing speed appear to be the cognitive domains that are predominantly associated with long-COVID syndrome, whereas language is an area that has not been sufficiently investigated. CONCLUSIONS In this review, the high frequency of cognitive impairment after COVID-19 is evident. If we consider that cognitive functioning affects our ability to live independently and is a key determinant of our quality of life, it is imperative to precisely define those factors that may induce cognitive impairment in COVID-19 survivors, with the ultimate goal of early diagnosis of cognitive changes and, consequently, the development of targeted rehabilitation interventions to address them.
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Affiliation(s)
- Eugenia Panagea
- Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychiatry, University of Patras Medical School, Patras, Greece
| | - Maria Christina Petri
- Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Emmanouil Anyfantis
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Panayiotis Patrikelis
- Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mary Kosmidis
- Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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de Pádua Serafim A, Saffi F, Soares ARA, Morita AM, Assed MM, de Toledo S, Rocca CCA, Durães RSS. Cognitive performance of post-covid patients in mild, moderate, and severe clinical situations. BMC Psychol 2024; 12:236. [PMID: 38671529 PMCID: PMC11046800 DOI: 10.1186/s40359-024-01740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Studying individuals with varying symptoms, from mild to severe, can provide valuable insights into the spectrum of cognitive outcomes after COVID-19. We investigated the cognitive performance of adults who recovered from the novel coronavirus disease (COVID-19) without prior cognitive complaints, considering mild (not hospitalized), moderate (ward), and severe (intensive care unit) symptoms. METHODS This cross-sectional study included 302 patients who recovered from COVID-19 (mild, n = 102; moderate, n = 102; severe, n = 98). We assessed intellectual quotient (IQ), attention, memory, processing speed, visual-constructive ability, as well as symptoms of depression, anxiety, and stress, at least eighteen months after infection. The mean length of hospitalization was Mdays=8.2 (SD = 3.9) and Mdays=14.4 (SD = 8.2) in the moderate and severe groups, respectively. RESULTS Cognitive difficulties were present in all three groups: mild (n = 12, 11.7%), moderate (n = 40, 39.2%), and severe (n = 48, 48.9%). Using Multinomial Logistic Regression and considering the odds ratio, our results indicated that a one-point increase in sustained attention, visual memory, and working memory might decrease the odds of being categorized in the severe group by 20%, 24%, and 77%, respectively, compared to the mild group. CONCLUSIONS Our findings provide empirical evidence regarding the long-term cognitive effects of COVID-19, particularly in individuals experiencing severe manifestations of the disease. We also highlighted the need for a comprehensive, multidimensional approach in rehabilitation programs to address the enduring cognitive impacts of COVID-19.
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Affiliation(s)
| | - Fabiana Saffi
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Sandro de Toledo
- Institute of Psychology, University of Brasília, Brasília, Brazil
| | | | - Ricardo S S Durães
- Institute of Psychology, University of São Paulo, São Paulo, Brazil
- Institute of Psychology, University of Brasília, Brasília, Brazil
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8
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Le GH, Kwan ATH, Guo Z, Wong S, Badulescu S, Gill H, Teopiz KM, Meshkat S, Ceban F, Phan L, Subramaniapillai M, Di Vincenzo JD, Rosenblat JD, Mansur RB, d'Andrea G, Ho R, Rhee TG, McIntyre RS. Impact of elevated body mass index (BMI) on cognitive functioning and inflammation in persons with post-COVID-19 condition: a secondary analysis. Acta Neuropsychiatr 2024:1-7. [PMID: 38605630 DOI: 10.1017/neu.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Individuals who have recovered from the acute stage of SARS-CoV-2 infection may be at risk of developing post-COVID-19 condition (PCC), characterised by a spectrum of persisting, non-specific, and functionally impairing symptoms across multiple organ systems. Obesity has been implicated as a risk factor for PCC, mediated by chronic systemic inflammation. The foregoing has also been separately reported to mediate cognitive dysfunction in PCC. METHODS This is a post-hoc analysis of a randomised, double-blinded, placebo-controlled clinical trial evaluating vortioxetine treatment for cognitive impairments in persons with PCC who received vortioxetine or placebo for eight weeks. This analysis comprises baseline data, examining the impact of BMI on cognitive functioning measured by the Digit Symbol Substitution Test (DSST) and Trails Making Tests (TMT)-A/B, as well as inflammation, via serum c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). RESULTS Complete data from 70 participants were statistically analysed and adjusted for age and sex. BMI was negatively correlated with performance on the DSST (β = -0.003, p = 0.047), TMT-A (β = -0.006, p = 0.025), and TMT-B (β = -0.006, p = 0.002). BMI was positively correlated with serum CRP (unstandardized β = 0.193, standardized β = 0.612, p < 0.001) and ESR (β = 0.039, p < 0.001) levels. CONCLUSION We observed a significant negative correlation between BMI and cognitive functioning, and a significant positive correlation between BMI and inflammation in persons with PCC, suggesting a bidirectional interplay between BMI, PCC, and cognitive function; individuals with an elevated BMI may be at a greater risk of developing PCC and/or presenting with greater cognitive deficits mediated by chronic systemic inflammation.
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Affiliation(s)
- Gia Han Le
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Angela T H Kwan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Sebastian Badulescu
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Hartej Gill
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Shakila Meshkat
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Michael G. DeGroote School of Medicine. McMaster University, Hamilton, ON, Canada
| | - Lee Phan
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | | | - Joshua D Rosenblat
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Giacomo d'Andrea
- Department of Neuroscience, Imaging and Clinical Sciences University "G d'Annunzio", Chieti, Italy
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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Boesl F, Goereci Y, Schweitzer F, Finke C, Schild AK, Bittner S, Steffen F, Schröder M, Quitschau A, Heine J, Warnke C, Franke C. Cognitive decline in post-COVID-19 syndrome does not correspond with persisting neuronal or astrocytic damage. Sci Rep 2024; 14:5326. [PMID: 38438479 PMCID: PMC10912552 DOI: 10.1038/s41598-024-55881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Cognitive impairment is the most frequent symptom reported in post-COVID-19 syndrome (PCS). Aetiology of cognitive impairment in PCS is still to be determined. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are increased in acute COVID-19. Their role as biomarkers in other neurological disorders is under debate. We analysed serum levels of NfL and GFAP as markers for neuronal and astrocytic damage in 53 patients presenting to a PCS Neurology outpatient clinic. Only individuals with self-reported cognitive complaints were included. In these individuals, cognitive complaints were further assessed by comprehensive neuropsychological assessment (NPA). Patients were categorized into subgroups of subjective cognitive decline, single domain impairment, or multi-domain impairment. Serum NfL was in normal range, however an increase of serum GFAP was detected in 4% of patients. Serum NfL and GFAP levels correlated with each other, even when adjusting for patient age (r = 0.347, p = 0.012). NPA showed deficits in 70%; 40% showing impairment in several tested domains. No significant differences were found between serum NfL- and GFAP-levels comparing patients with subjective cognitive decline, single domain impairment, or multi-domain impairment. Persistent neuronal or astrocytic damage did not correlate with cognitive impairment in PCS.
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Affiliation(s)
- Fabian Boesl
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ann-Katrin Schild
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Maria Schröder
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anneke Quitschau
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Josephine Heine
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
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10
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Demir E, Veizi BGY, Naharci MI. Long-Term Risk of Reduced Cognitive Performance and Associated Factors in Discharged Older Adults with COVID-19: A Longitudinal Prospective Study. Ann Geriatr Med Res 2024; 28:76-85. [PMID: 38225807 PMCID: PMC10982451 DOI: 10.4235/agmr.23.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/23/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Increasing numbers of reports have suggested a deterioration in cognitive performance after recovery from coronavirus disease 2019 (COVID-19), however insufficient information is available regarding long-term brain health and risk factors related to reduced cognitive performance in advanced age. We investigated the prevalence of reduced cognitive performance and its associated factors among older adults after COVID-19. METHODS This prospective observational study enrolled older individuals (aged ≥65 years) hospitalized for COVID-19. Discharged patients were contacted after an average of 15 months and a brief battery was administered during telephone interviews to assess their mental status. RESULTS Among the 174 patients, 77 (44.3%) showed reduced cognitive performance at follow-up. Multivariate analysis revealed that female sex, education level, and increased Deyo/Charlson Comorbidity Index score, which is an objective indicator of chronic disease burden, were independent risk factors for long-term cognitive performance. Depression and anxiety symptoms, assessed using the Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item questionnaire at the end of the study, were not associated with reduced cognitive performance. CONCLUSION Our findings provide key insights into discharged older adults with COVID-19 at risk of long-term cognitive impairment, and help to ascertain the factors associated with this problem.
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Affiliation(s)
- Elif Demir
- Department of Internal Medicine, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Betül Gülsüm Yavuz Veizi
- Department of Geriatrics, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Mehmet Ilkin Naharci
- Department of Geriatrics, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
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11
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Hampshire A, Azor A, Atchison C, Trender W, Hellyer PJ, Giunchiglia V, Husain M, Cooke GS, Cooper E, Lound A, Donnelly CA, Chadeau-Hyam M, Ward H, Elliott P. Cognition and Memory after Covid-19 in a Large Community Sample. N Engl J Med 2024; 390:806-818. [PMID: 38416429 PMCID: PMC7615803 DOI: 10.1056/nejmoa2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear. METHODS We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating ("brain fog"). RESULTS Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no-Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (-0.23 SD [95% confidence interval {CI}, -0.33 to -0.13] and -0.24 SD [95% CI, -0.36 to -0.12], respectively); larger deficits as compared with the no-Covid-19 group were seen in participants with unresolved persistent symptoms (-0.42 SD; 95% CI, -0.53 to -0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., -0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, -0.20 to -0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, -0.35 SD; 95% CI, -0.49 to -0.20). Results of the analyses were similar to those of propensity-score-matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no-Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (-0.33 to -0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported. CONCLUSIONS Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.).
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Affiliation(s)
- Adam Hampshire
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adriana Azor
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christina Atchison
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - William Trender
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Peter J Hellyer
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Valentina Giunchiglia
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Masud Husain
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Graham S Cooke
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Emily Cooper
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adam Lound
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christl A Donnelly
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Marc Chadeau-Hyam
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Helen Ward
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Paul Elliott
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
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12
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Duan X, Huang Z, Zhang S, Zhu G, Wang R, Wang Z. SARS-CoV-2 Infection Impairs Oculomotor Functions: A Longitudinal Eye-tracking Study. J Eye Mov Res 2024; 17:10.16910/jemr.17.1.2. [PMID: 38694262 PMCID: PMC11060831 DOI: 10.16910/jemr.17.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Although Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2) is primarily recognized as a respiratory disease, mounting evidence suggests that it may lead to neurological and cognitive impairments. The current study used three eye-tracking tasks (free-viewing, fixation, and smooth pursuit) to assess the oculomotor functions of mild infected cases over six months with symptomatic SARS-CoV-2 infected volunteers. Fifty symptomatic SARS-CoV-2 infected, and 24 self-reported healthy controls completed the eye-tracking tasks in an initial assessment. Then, 45, and 40 symptomatic SARS-CoV-2 infected completed the tasks at 2- and 6-months post-infection, respectively. In the initial assessment, symptomatic SARS-CoV-2 infected exhibited impairments in diverse eye movement metrics. Over the six months following infection, the infected reported overall improvement in health condition, except for self-perceived mental health. The eye movement patterns in the free-viewing task shifted toward a more focal processing mode and there was no significant improvement in fixation stability among the infected. A linear discriminant analysis shows that eye movement metrics could differentiate the infected from healthy controls with an accuracy of approximately 62%, even 6 months post-infection. These findings suggest that symptomatic SARSCoV- 2 infection may result in persistent impairments in oculomotor functions, and the employment of eye-tracking technology can offer valuable insights into both the immediate and long-term effects of SARS-CoV-2 infections. Future studies should employ a more balanced research design and leverage advanced machine-learning methods to comprehensively investigate the impact of SARSCoV- 2 infection on oculomotor functions.
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Affiliation(s)
| | | | | | | | - Rong Wang
- Zhejiang Sci-Tech University, Hangzhou, China
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13
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Cho SM, Premraj L, Battaglini D, Fanning JP, Suen J, Bassi GL, Fraser J, Robba C, Griffee M, Solomon T, Semple MG, Baillie K, Sigfrid L, Scott JT, Citarella BW, Merson L, Arora RC, Whitman G, Thomson D, White N. Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after coronavirus disease 2019 hospitalization: an international multi-centre prospective observational study. Brain Commun 2024; 6:fcae036. [PMID: 38444907 PMCID: PMC10914448 DOI: 10.1093/braincomms/fcae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39-1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60-0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - Lavienraj Premraj
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Griffith University School of Medicine, Gold Coast 4215, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
| | - Denise Battaglini
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
- Department of Medicine, University of Barcelona, Barcelona 08036, Spain
| | - Jonathon Paul Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Gianluigi Li Bassi
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - John Fraser
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- St Andrew’s War Memorial Hospital, UnitingCare, Spring Hill 4000, Australia
| | - Chiara Robba
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
| | - Matthew Griffee
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Tom Solomon
- Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, L3 5TR, UK
- Department of Neuroscience, University of Liverpool, Liverpool, L3 5TR, UK
- Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Malcolm G Semple
- Child Health and Outbreak Medicine, University of Liverpool, Liverpool, L3 5TR, UK
| | - Kenneth Baillie
- Experimental Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7LG, UK
| | - Janet T Scott
- Infectious Disease, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, OX1 2JD, UK
| | - Laura Merson
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - Rakesh C Arora
- Department of Surgery, University Hospitals/Case Western Reserve University, Cleveland, OH 44106, USA
| | - Glenn Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - David Thomson
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town 7700, South Africa
- Division of Critical Care, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Nicole White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
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14
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Zhang S, Yuan M, He D, Dang W, Zhang W. Long-term follow-up of brain regional changes and the association with cognitive impairment in quarantined COVID-19 survivors. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01741-4. [PMID: 38319396 DOI: 10.1007/s00406-023-01741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This study aimed to evaluate the neuropsychiatric symptoms of quarantined COVID-19 survivors 15 months after discharge and explore its potential association with structural and functional brain changes and inflammation. METHODS A total of 51 quarantined COVID-19 survivors and 74 healthy controls were included in this study. Cognitive function was assessed using the THINC-integrated tool. Structural brain changes were examined through both surface- and volume-based analyses, and functional changes were assessed using resting-state amplitude low-frequency fluctuation (ALFF). Serum inflammatory markers were measured by a multiplexed flow cytometric assay. RESULTS COVID-19 survivors exhibited subjective cognitive decline compared to healthy controls, despite no significant differences in objective cognitive tasks. Structural analysis revealed significantly increased gray matter volume and cortical surface area in the left transverse temporal gyrus (Heschl's gyrus) in quarantined COVID-19 survivors. This enlargement was negatively correlated with cognitive impairment. The ALFF analysis showed decreased neural activity in multiple brain regions. Elevated levels of serum inflammatory markers were also found in COVID-19 survivors, including MIP-1a, MIP-1b, TNF-a, and IL-8, which correlated with functional abnormalities. CONCLUSIONS Our findings indicate a subjective cognitive decline in quarantined COVID-19 survivors 15 months after discharge, which is associated with brain structural alterations in the left Heschl's gyrus. The observed elevation of inflammatory markers suggests a potential mechanism involving inflammation-induced neurogenesis. These results contribute to our understanding of the possible mechanisms underlying long-term neuropsychiatric consequences of COVID-19 and highlight the need for further research to develop targeted interventions.
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Affiliation(s)
- Simai Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Minlan Yuan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Danmei He
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wen Dang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China.
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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15
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Vakani K, Ratto M, Sandford-James A, Antonova E, Kumari V. Cognitive and mental health trajectories of COVID-19: Role of hospitalisation and long-COVID symptoms. Eur Psychiatry 2024; 67:e17. [PMID: 38312039 DOI: 10.1192/j.eurpsy.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND There is considerable evidence of cognitive impairment post COVID-19, especially in individuals with long-COVID symptoms, but limited research objectively evaluating whether such impairment attenuates or resolves over time, especially in young and middle-aged adults. METHODS Follow-up assessments (T2) of cognitive function (processing speed, attention, working memory, executive function, memory) and mental health were conducted in 138 adults (18-69 years) who had been assessed 6 months earlier (T1). Of these, 88 had a confirmed history of COVID-19 at T1 assessment (≥20 days post-diagnosis) and were also followed-up on COVID-19-related symptoms (acute and long-COVID); 50 adults had no known COVID-19 history at any point up to their T2 assessment. RESULTS From T1 to T2, a trend-level improvement occurred in intra-individual variability in processing speed in the COVID, relative to the non-COVID group. However, longer response/task completion times persisted in participants with COVID-19-related hospitalisation relative to those without COVID-19-related hospitalisation and non-COVID controls. There was a significant reduction in long-COVID symptom load, which correlated with improved executive function in non-hospitalised COVID-19 participants. The COVID group continued to self-report poorer mental health, irrespective of hospitalisation history, relative to non-COVID group. CONCLUSIONS Although some cognitive improvement has occurred over a 6-month period in young and middle-aged COVID-19 survivors, cognitive impairment persists in those with a history of COVID-19-related hospitalisation and/or long-COVID symptoms. Continuous follow-up assessments are required to determine whether cognitive function improves or possibly worsens, over time in hospitalised and long-COVID participants.
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Affiliation(s)
- Krupa Vakani
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | | | | | - Elena Antonova
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Veena Kumari
- Centre for Cognitive and Clinical Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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16
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Tamadoni N, Bakhtiari A, Nikbakht HA. Psychometric properties of the COVID-19 Yorkshire Rehabilitation Scale: Post-Covid-19 syndrome in Iranian elderly population. BMC Infect Dis 2024; 24:77. [PMID: 38212717 PMCID: PMC10785474 DOI: 10.1186/s12879-024-08991-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study aimed to assess the construct validity and reliability of the Iranian version of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) among the elderly population. METHOD A cohort of 230 elderly individuals who tested positive for Covid-19 via PCR were administered a health and demographic information questionnaire along with the C19-YRS. Both exploratory and confirmatory factor analyses were conducted, and Cronbach's alpha was calculated. RESULTS Findings from the exploratory and confirmatory factor analyses of the C19-YRS revealed alterations compared to the original version, resulting in an adapted version with three factors achieved by redistributing the questions. These factors accounted for 57.46% of the total variance. Despite a relatively lower factor loading in the 6th question, it was retained due to its significance among the elderly. The Cronbach's alpha for the C19-YRS subscales ranged from 0.730 to 0.890, indicating acceptable reliability. CONCLUSION The validation results indicated a well-adjusted factor structure and internal consistency, affirming the utility of this tool among the elderly population. Consequently, the C19-YRS in Iran can serve as a valuable resource in healthcare settings, aiding in the assessment of chronic complications arising from Covid-19 in the elderly. It can be utilized as an initial screening or triage test and to evaluate the effectiveness of interventions.
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Affiliation(s)
- Negar Tamadoni
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Afsaneh Bakhtiari
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
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17
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Panzeri A, DeVita M, Di Rosa E, Bottesi G, Brundisini V, Guarrera C, Ravelli A, Ponza I, Cattelan A, Volpe B, Iannizzi P, Ghisi M, Schiavo R, Mapelli D. Trauma Shaping the Psychopathological Correlates of Patients with Long-COVID: A 6-Months Longitudinal Study with Repeated Measures Mixed Models. Psychiatry Res 2023; 330:115609. [PMID: 38006716 DOI: 10.1016/j.psychres.2023.115609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
This research aimed at investigating how the experience of trauma can influence the psychological correlates of long-COVID over time in a clinical sample of patients hospitalized because of COVID-19. Through a longitudinal research design, 70 post-acute patients with COVID-19 were followed-up after hospital discharge in 3-time points up to 6 months and completed the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Symptoms Checklist-90-Revised (SCL-90 R). Repeated measures mixed models with random intercept were used to evaluate the effect of trauma (yes/no) over time (T1, T2, T3) on the SCL-90-R scales. Results showed that patients with trauma display significantly worse psychological outcomes in all the SCL-90-R dimensions [all padj < .05 for the principal effects of trauma(y)], especially in symptoms of depression [time 2 vs time 1*trauma(y): b = -3.86, 95%CI (-7.18, -0.53), padj = .035; time 3 vs time 1*trauma(y): b = -4.77, 95%CI (-8.10, -1.45), padj = .011], anxiety [time 3 vs time 1*trauma(y): b = -4.54, 95%CI (-7.72, -1.37), padj = .011], and obsessive-compulsive difficulties [time 3 vs time 1*trauma(y): b = -4.03, 95%CI (-7.20, -0.86), padj = .027]. These findings shed light on the long-term psychological consequences of COVID-19 among hospitalized patients and highlight the key role of trauma, suggesting its assessment to tailor psychological interventions.
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Affiliation(s)
- Anna Panzeri
- Department of General Psychology, University of Padua, Italy.
| | - Maria DeVita
- Department of General Psychology, University of Padua, Italy; Geriatrics Division, Department of Medicine, University of Padua, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padua, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padua, Italy
| | - Virginia Brundisini
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Claudia Guarrera
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Adele Ravelli
- Geriatrics Division, Department of Medicine, University of Padua, Italy
| | - Isabella Ponza
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Biancarosa Volpe
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | | | - Marta Ghisi
- Department of General Psychology, University of Padua, Italy; Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Rossana Schiavo
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padua, Italy
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18
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Tsiaras Y, Kitsakis N, Papadopoulou E, Karanikas E, Kourbetis D, Aretouli E. Neuropsychological Profile of Hospitalized Patients Due to COVID-19: Clinical and Inflammatory Correlates. Arch Clin Neuropsychol 2023; 38:1564-1577. [PMID: 37210601 DOI: 10.1093/arclin/acad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES In the present study, we investigated the pattern of cognitive difficulties in hospitalized patients due to COVID-19 and its relation with the clinical features of the disease. METHOD Forty hospitalized patients with COVID-19 [mean age: 46.98 years (SD = 9.30); mean years of education: 13.65 (SD = 2.07) and 40 sex-, age- and education-matched healthy controls completed a set of neuropsychological measures administered by telephone. Participants' premorbid intellectual skills and patients' anxiety and depressive symptoms were also evaluated. The association of COVID-19-related biomarkers [oxygen saturation (SpO2), C-reactive protein (CRP), D-dimer and ferritin levels] with neuropsychological performances was examined with a series of hierarchical multiple linear regression analyses, after controlling for demographic and clinical characteristics, psychological distress and premorbid intellectual skills. RESULTS Patients performed worse than healthy participants on measures of verbal memory, attention and working memory. SpO2 levels were associated with patients' performance on verbal and working memory, whereas CRP levels were associated with performance on verbal memory, abstract reasoning and verbal fluency, after controlling for demographic and clinical characteristics. Ferritin levels predicted performance on the verbal fluency test, whereas D-dimer levels did not predict any of the neuropsychological measures. CONCLUSIONS Cognitive difficulties in verbal memory, attention and working memory were noted in patients with COVID-19. Markers of hyperinflammation predicted patients' performance above and beyond demographic characteristics, duration of symptoms, length of hospitalization and psychological distress.
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Affiliation(s)
- Yiannis Tsiaras
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
- School of the Social Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Kitsakis
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Eleftheria Papadopoulou
- Cognitive Neuroscience Lab, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki Greece
| | | | | | - Eleni Aretouli
- School of the Social Sciences, University of Ioannina, Ioannina, Greece
- Cognitive Neuroscience Lab, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki Greece
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19
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Ballestar-Tarín ML, Ibáñez-del Valle V, Mafla-España MA, Cauli O, Navarro-Martínez R. Increased Salivary IL-1 Beta Level Is Associated with Poor Sleep Quality in University Students. Diseases 2023; 11:136. [PMID: 37873780 PMCID: PMC10594478 DOI: 10.3390/diseases11040136] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023] Open
Abstract
Poor sleep quality is a major public health concern for all ages. In particular, university students often face stress levels and changes in social life habits that negatively influence their quality of sleep. This could be associated with psychological well-being in terms of anxiety and depressive symptoms, stress levels, and a poor self-perceived health status. The increases in the pro-inflammatory cytokine interleukin 6 (IL-6), IL-1 beta (IL-1β), and tumor necrosis factor alpha (TNFα), in blood have been linked to poor sleep quality in many diseases, but data on salivary cytokine levels in students are missing or are seldom analyzed. In this study we determined the quality of sleep in a sample of university students and the role of psychological assessment and factors affecting sleep (alcohol intake, tobacco, consumption of stimulant drinks, exercise, and body mass index). We also aimed to shed new light on the associations between sleep quality and salivary inflammatory cytokines (IL-1β, IL-6, and TNFα). Sleep quality was measured with the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI). Perceived stress was assessed using Cohen's Perceived Stress Scale (PSS), and the Goldberg Anxiety and Depression Scale (GADS) was used to assess the level of anxiety or depression. Perceived health status was measured with a visual analogue. Saliva samples was taken in the morning and the inflammatory cytokines was measured via enzyme-linked immunoassay. There was a direct and significant association between the salivary IL-1β concentration and AIS score (r = 0.248; p = 0.038, Pearson correlation) and Pittsburgh scale score (r = 0.274; p = 0.022, Pearson correlation). The relationship between IL-1β and AIS controlling for sex, age, and chronic disease, is still significant (r = 0.260; p = 0.033). The relationship between IL-1β and PSQI controlling for the influence of these variables is also significant (r = 0.279; p = 0.022). Salivary IL-1β concentrations were not significantly associated with any of the scores of the other psychological assessments (PSS, anxiety, depression symptoms, or self-perceived health). Salivary TNFα was significantly and inversely associated with self-perceived health (r = -0.259; p = 0.033, Pearson correlation), but the salivary IL-6 concentration was not associated with any of the sleep quality scale or psychological assessment scores. Our results provide a novel relationship between pro-inflammatory cytokine IL-1β in saliva and poor sleep quality. However, the role of inflammation in poor sleep quality requires further study to identify strategies that could lower inflammation and thus, likely improve sleep quality.
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Affiliation(s)
- María Luisa Ballestar-Tarín
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.V.); (M.A.M.-E.); (R.N.-M.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
| | - Vanessa Ibáñez-del Valle
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.V.); (M.A.M.-E.); (R.N.-M.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Mayra Alejandra Mafla-España
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.V.); (M.A.M.-E.); (R.N.-M.)
| | - Omar Cauli
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.V.); (M.A.M.-E.); (R.N.-M.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Rut Navarro-Martínez
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.V.); (M.A.M.-E.); (R.N.-M.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Department of Hematology, University General Hospital, 46014 Valencia, Spain
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20
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Quan M, Wang X, Gong M, Wang Q, Li Y, Jia J. Post-COVID cognitive dysfunction: current status and research recommendations for high risk population. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100836. [PMID: 37457901 PMCID: PMC10344681 DOI: 10.1016/j.lanwpc.2023.100836] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Post-COVID cognitive dysfunction (PCCD) is a condition in which patients with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, usually three months from the onset, exhibit subsequent cognitive impairment in various cognitive domains, and cannot be explained by an alternative diagnosis. While our knowledge of the risk factors and management strategy of PCCD is still incomplete, it is necessary to integrate current epidemiology, diagnosis and treatment evidence, and form consensus criteria to better understand this disease to improve disease management. Identifying the risk factors and vulnerable population of PCCD and providing reliable strategies for effective prevention and management is urgently needed. In this paper, we reviewed epidemiology, diagnostic markers, risk factors and available treatments on the disease, formed research recommendation framework for vulnerable population, under the background of post-COVID period.
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Affiliation(s)
- Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Xuechu Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Min Gong
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Qi Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Yan Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
- Beijing Key Laboratory of Geriatric Cognitive Disorders, China
- Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, China
- Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
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21
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Tang CM, Li GHY, Cheung CL. COVID-19 and cognitive performance: a Mendelian randomization study. Front Public Health 2023; 11:1185957. [PMID: 37674675 PMCID: PMC10477606 DOI: 10.3389/fpubh.2023.1185957] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Background A substantial proportion of individuals with COVID-19 experienced cognitive impairment after resolution of SARS-CoV-2 infection. We aimed to evaluate whether genetic liability to SARS-CoV-2 infection per se, or more severe COVID-19, is causally linked to cognitive deficit. Methods We firstly performed univariable Mendelian randomization (MR) analysis to examine whether genetic liability to SARS-CoV-2 infection, hospitalized and severe COVID-19 is causally associated with cognitive performance. To dissect the causal pathway, multivariable MR (MVMR) analysis was conducted by adjusting for five inflammatory markers [C-reactive protein, interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor α, as proxies of systemic inflammation]. Results In univariable MR analysis, host genetic liability to SARS-CoV-2 infection was associated with lower cognitive performance [inverse variance weighted (IVW) analysis, estimate: -0.023; 95% Confidence Interval (CI): -0.038 to -0.009]. Such causal association was attenuated in MVMR analysis when we adjusted for the five correlated inflammatory markers in one analysis (IVW analysis, estimate: -0.022; 95% CI: -0.049 to 0.004). There was insufficient evidence of association for genetic liability to hospitalized and severe COVID-19 with cognitive performance. Conclusion The causal effect of host genetic liability to SARS-CoV-2 infection on reduced cognitive performance may be mediated by systemic inflammation. Future studies examining whether anti-inflammatory agents could alleviate cognitive impairment in SARS-CoV-2-infected individuals are warranted.
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Affiliation(s)
- Ching-Man Tang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Gloria Hoi-Yee Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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22
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Li Z, Zhang Z, Zhang Z, Wang Z, Li H. Cognitive impairment after long COVID-19: current evidence and perspectives. Front Neurol 2023; 14:1239182. [PMID: 37583958 PMCID: PMC10423939 DOI: 10.3389/fneur.2023.1239182] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023] Open
Abstract
COVID-19, caused by the SARS-CoV-2 virus, is a respiratory infectious disease. While most patients recover after treatment, there is growing evidence that COVID-19 may result in cognitive impairment. Recent studies reveal that some individuals experience cognitive deficits, such as diminished memory and attention, as well as sleep disturbances, suggesting that COVID-19 could have long-term effects on cognitive function. Research indicates that COVID-19 may contribute to cognitive decline by damaging crucial brain regions, including the hippocampus and anterior cingulate cortex. Additionally, studies have identified active neuroinflammation, mitochondrial dysfunction, and microglial activation in COVID-19 patients, implying that these factors may be potential mechanisms leading to cognitive impairment. Given these findings, the possibility of cognitive impairment following COVID-19 treatment warrants careful consideration. Large-scale follow-up studies are needed to investigate the impact of COVID-19 on cognitive function and offer evidence to support clinical treatment and rehabilitation practices. In-depth neuropathological and biological studies can elucidate precise mechanisms and provide a theoretical basis for prevention, treatment, and intervention research. Considering the risks of the long-term effects of COVID-19 and the possibility of reinfection, it is imperative to integrate basic and clinical research data to optimize the preservation of patients' cognitive function and quality of life. This integration will also offer valuable insights for responding to similar public health events in the future. This perspective article synthesizes clinical and basic evidence of cognitive impairment following COVID-19, discussing potential mechanisms and outlining future research directions.
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Affiliation(s)
- Zhitao Li
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen Zhang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuoya Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiyong Wang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Li
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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23
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Reiss AB, Greene C, Dayaramani C, Rauchman SH, Stecker MM, De Leon J, Pinkhasov A. Long COVID, the Brain, Nerves, and Cognitive Function. Neurol Int 2023; 15:821-841. [PMID: 37489358 PMCID: PMC10366776 DOI: 10.3390/neurolint15030052] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may arise from a virus-induced hypercoagulable state. COVID-19 may incite changes in brain function with a wide range of lingering symptoms. Patients often experience fatigue and may note brain fog, sensorimotor symptoms, and sleep disturbances. Prolonged neurological and neuropsychiatric symptoms are prevalent and can interfere substantially in everyday life, leading to a massive public health concern. The mechanistic pathways by which SARS-CoV-2 infection causes neurological sequelae are an important subject of ongoing research. Inflammation- induced blood-brain barrier permeability or viral neuro-invasion and direct nerve damage may be involved. Though the mechanisms are uncertain, the resulting symptoms have been documented from numerous patient reports and studies. This review examines the constellation and spectrum of nervous system symptoms seen in long COVID and incorporates information on the prevalence of these symptoms, contributing factors, and typical course. Although treatment options are generally lacking, potential therapeutic approaches for alleviating symptoms and improving quality of life are explored.
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Affiliation(s)
- Allison B Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Caitriona Greene
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Christopher Dayaramani
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | | | | | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Aaron Pinkhasov
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
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24
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Fesharaki Zadeh A, Arnsten AFT, Wang M. Scientific Rationale for the Treatment of Cognitive Deficits from Long COVID. Neurol Int 2023; 15:725-742. [PMID: 37368329 PMCID: PMC10303664 DOI: 10.3390/neurolint15020045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Sustained cognitive deficits are a common and debilitating feature of "long COVID", but currently there are no FDA-approved treatments. The cognitive functions of the dorsolateral prefrontal cortex (dlPFC) are the most consistently afflicted by long COVID, including deficits in working memory, motivation, and executive functioning. COVID-19 infection greatly increases kynurenic acid (KYNA) and glutamate carboxypeptidase II (GCPII) in brain, both of which can be particularly deleterious to PFC function. KYNA blocks both NMDA and nicotinic-alpha-7 receptors, the two receptors required for dlPFC neurotransmission, and GCPII reduces mGluR3 regulation of cAMP-calcium-potassium channel signaling, which weakens dlPFC network connectivity and reduces dlPFC neuronal firing. Two agents approved for other indications may be helpful in restoring dlPFC physiology: the antioxidant N-acetyl cysteine inhibits the production of KYNA, and the α2A-adrenoceptor agonist guanfacine regulates cAMP-calcium-potassium channel signaling in dlPFC and is also anti-inflammatory. Thus, these agents may be helpful in treating the cognitive symptoms of long COVID.
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Affiliation(s)
- Arman Fesharaki Zadeh
- Departments of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
- Departments of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Amy F. T. Arnsten
- Departments of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Min Wang
- Departments of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA;
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Gollop C, Zingel R, Jacob L, Smith L, Koyanagi A, Kostev K. Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study. J Alzheimers Dis 2023:JAD221271. [PMID: 37212106 DOI: 10.3233/jad-221271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. OBJECTIVE The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. METHODS This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). RESULTS The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). CONCLUSION This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.
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Affiliation(s)
| | | | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
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26
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Tripathy S, Kar SK. Comments on "Long term neuropsychiatric consequences in COVID-19 survivors: Cognitive impairment and inflammatory underpinnings fifteen months after discharge". Asian J Psychiatr 2023; 82:103455. [PMID: 36652836 PMCID: PMC9817336 DOI: 10.1016/j.ajp.2023.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Affiliation(s)
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
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