Neurocognitive and psychiatric symptoms following infection with COVID-19: Evidence from laboratory and population studies

Exploring Neurocognitive and Emotional Outcomes of Long COVID: A Study Among Pakistani Patients

Background and objective Coronavirus disease 2019 (COVID-19), primarily a respiratory illness, also significantly impacts neurocognitive and emotional health, particularly in its long-term manifestation known as long COVID. This study aimed to investigate the neurocognitive and emotional outcomes of long-term COVID-19 in Pakistani patients, to address the persisting symptoms and their effects on mental health and cognitive function. Methods A cross-sectional study involving 100 adult participants who had been COVID-19-free was conducted in Islamabad between March 2022 and March 2023. Participants were assessed using the Mini-Mental State Examination (MMSE), attention-deficit/hyperactivity disorder (ADHD) Self-Report Questionnaire, Satisfaction with Life Scale (SWLS), and Punishing Allah Reappraisal Scale. Data were analyzed using SPSS Statistics v26 (IBM Corp., Armonk, NY), employing chi-square tests, t-tests, and ANOVA. Results The study revealed significant correlations between COVID-19 symptoms and psychological variables. COVID-19 symptoms showed a negative correlation with MMSE scores (r = -0.04, p<0.01) and positive correlations with ADHD (r = 0.13, p<0.05), depression (r = 0.14, p<0.05), and anxiety (r = 0.25, p<0.05). Females reported higher levels of depression [mean: 1.21, standard deviation (SD): 0.83] and anxiety (mean: 1.33, SD: 0.86) compared to males. Conclusions Our findings highlight the extensive impact of long-term COVID-19 on neurocognitive and emotional health, with significant gender differences observed in emotional outcomes. These results emphasize the need for integrated mental health services in post-COVID-19 care plans, as well as gender-sensitive interventions.

Potential pathophysiological role of the ion channel TRPM3 in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and the therapeutic effect of low-dose naltrexone

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disease with a broad overlap of symptomatology with Post-COVID Syndrome (PCS). Despite the severity of symptoms and various neurological, cardiovascular, microvascular, and skeletal muscular findings, no biomarkers have been identified. The Transient receptor potential melastatin 3 (TRPM3) channel, involved in pain transduction, thermosensation, transmitter and neuropeptide release, mechanoregulation, vasorelaxation, and immune defense, shows altered function in ME/CFS. Dysfunction of TRPM3 in natural killer (NK) cells, characterized by reduced calcium flux, has been observed in ME/CFS and PCS patients, suggesting a role in ineffective pathogen clearance and potential virus persistence and autoimmunity development. TRPM3 dysfunction in NK cells can be improved by naltrexone in vitro and ex vivo, which may explain the moderate clinical efficacy of low-dose naltrexone (LDN) treatment. We propose that TRPM3 dysfunction may have a broader involvement in ME/CFS pathophysiology, affecting other organs. This paper discusses TRPM3's expression in various organs and its potential impact on ME/CFS symptoms, with a focus on small nerve fibers and the brain, where TRPM3 is involved in presynaptic GABA release.

rTMS for post-covid-19 condition: A sham-controlled case series involving iTBS-300 and iTBS-600

Post-Covid-19 Condition (PCC) is a syndrome comprised of symptoms persisting 3 months or more beyond SARS-CoV-2 primary infection. It is typically characterized by fatigue, cognitive problems and psychiatric symptoms, as well as cardiac symptoms that contribute to exercise intolerance in many. Despite the high prevalence of PCC among those with a prior SARS-CoV-2 infection, there is currently no widely accepted rehabilitation strategy, and many conventional modalities are movement-based. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) may have some potential to alleviate the cognitive and affective symptoms of PCC without reliance on exercise. The purpose of the present study was to explore the feasibility and tolerability of using rTMS to treat symptoms of "brain fog" and affective disturbance among those living with PCC, using a case series design. We enrolled four individuals with PCC following a confirmed SARS-CoV-2 infection, at least 3 months after the resolution of the primary infection. Participants were randomized to 4 sessions of active and 2 sessions of sham intermittent theta-burst stimulation (iTBS); two intensities of iTBS were evaluated: iTBS-300 and iTBS-600. No adverse events occurred in active or sham stimulation; 2 participants reported tingling sensation on the scalp but no other tolerability issues. Trends in symptoms suggested improvements in cognitive interference, quality of life, and anxiety in the majority of participants. In summary, in this case series iTBS was well tolerated among 4 individuals with PCC; active stimulation was associated with positive trends in some primary symptom clusters as compared with sham stimulation. Future studies should examine the effects of iTBS on PCC symptoms in the context of experimental studies and randomized controlled trials.

A mini-review on how the COVID-19 pandemic affected intertemporal choice

The coronavirus disease (COVID-19) has extremely harmful effects on individual lifestyles, and at present, people must make financial or survival decisions under the profound changes frequently. Although it has been reported that COVID-19 changed decision-making patterns, the underlying mechanisms remained unclear. This mini-review focuses on the impact of the COVID-19 pandemic on intertemporal choice, and potential psychological, biological, and social factors that mediate this relationship. A search of the Web of Science electronic database yielded 23 studies. The results showed that under the COVID-19 pandemic, people tended to choose immediate and smaller rewards, and became less patient. In particular, people with negative emotions, in a worse condition of physical health, or who did not comply with their government restriction rules tended to become more "short-sighted" in behavioral terms. Future studies should examine more longitudinal and cross-cultural research to give a broad view about the decision-making change under the COVID-19 pandemic.

Characterizing long-COVID brain fog: a retrospective cohort study

BACKGROUND

Long COVID or post-COVID condition (PCC) is a common complication following acute COVID-19 infection. PCC is a multi-systems disease with neurocognitive impairment frequently reported regardless of age. Little is known about the risk factors, associated biomarkers and clinical trajectory of patients with this symptom.

OBJECTIVE

To determine differences in clinical risk factors, associated biochemical markers and longitudinal clinical trajectories between patients with PCC with subjective neurocognitive symptoms (NC+) or without (NC-).

METHODS

A retrospective longitudinal cohort study was performed using a well-characterized provincial database of patients with clinically confirmed PCC separated into NC+ and NC- cohorts. Demographical, clinical and biochemical differences at initial consultation between the two patient cohorts were analyzed in cross-section. Multivariate regression analyses were conducted to identify independent risk factors for neurocognitive impairment. Determination of the recovery trajectory was performed using serial assessments of the patient-reported health-related quality of life (HR-QoL) metric Eq-5D-5L-vas score.

FINDINGS

Women, milder acute infection and pre-existing mental health diagnoses were independently associated with subjective neurocognitive impairment at 8 months post-infection. NC + patients demonstrated lower levels of IgG, IgG1 and IgG3 compared to NC- patients. The NC + cohort had poorer HR-QoL at initial consultation 8 months post-infection with gradual improvement over 20 months post-infection.

CONCLUSIONS

Neurocognitive impairment represents a severe phenotype of PCC, associated with unique risk factors, aberrancy in immune response and a delayed recovery trajectory. Those with risk factors for neurocognitive impairment can be identified early in the disease trajectory for more intense medical follow-up.

Determinants of post discharge mortality among hospitalized COVID-19 patients

Background & objectives

The post-acute effects of COVID-19 are continually being updated. This investigation was conducted to evaluate the determinants of post discharge mortality in hospitalized COVID-19 patients, especially 18-45 yr of age.

Methods

A series of three nested case-control analyses was conducted on follow up data collected in the National Clinical Registry for COVID-19 between September 2020 and February 2023 from 31 hospitals. Matching (1:4) was done by the date of hospital admission ±14 days for the following comparisons: (i) case-patients reported as dead vs. controls alive at any contact within one year follow up; (ii) the same in the 18-45 yr age group and (iii) case-patients reported as dead between the first and one year of follow up vs. controls alive at one year post discharge.

Results

The one year post discharge mortality was 6.5 per cent (n=942). Age [≤18 yr: adjusted odds ratio (aOR) (95% confidence interval [CI]): 1.7 (1.04, 2.9); 40-59 yr: aOR (95% CI): 2.6 (1.9, 3.6); ≥60 yr: aOR (95% CI): 4.2 (3.1, 5.7)], male gender [aOR (95% CI): 1.3 (1.1, 1.5)], moderate-to-severe COVID-19 [aOR (95% CI): 1.4 (1.2, 1.8)] and comorbidities [aOR (95%CI): 1.8 (1.4, 2.2)] were associated with higher odds of post-discharge one-year mortality, whereas 60 per cent protection was conferred by vaccination before the COVID-19 infection. The history of moderate-to-severe COVID-19 disease [aOR (95% CI): 2.3 (1.4, 3.8)] and any comorbidities [aOR (95% CI): 3 (1.9, 4.8)] were associated with post-discharge mortality in the 18-45-yr age bracket as well. Post COVID condition (PCC) was reported in 17.1 per cent of the participants. Death beyond the first follow up was associated with comorbidities [aOR (95%CI): 9.4 (3.4, 26.1)] and reported PCC [aOR (95% CI): 2.7 (1.2, 6)].

Interpretation & conclusions

Prior vaccination protects against post discharge mortality till one year in hospitalized COVID-19 patients. PCC may have long term deleterious effects, including mortality, for which further research is warranted.