The Impact of the COVID-19 Pandemic on Dementia Risk: Potential Pathways to Cognitive Decline

Synthesis of new selective agents with dual anti-inflammatory and SARS-CoV-2 Mpro inhibitory activity: Antipyrine-celecoxib hybrid analogues; COX-2, COVID-19 cytokine storm and replication inhibitory activities

Herein, a great aim to introduce novel pyrazolone derivatives with multiple activities, including selective COX-2 and cytokine inhibition in addition to SARS-CoV-2 Mpro inhibitory effects. All the synthesized compounds 4a-c, 5, 6a,b, 7a-f, 8a,b, 9a,b, 10a,b and 11a-f were evaluated in vitro for investigation of selective COX-2 inhibitory activity. The results introduced the most selective compounds 7a, 7d, 7e, 9a, and 11f that were further screened in vivo to evaluate their anti-inflammatory activity, safety concerning gastric ulcer and myocardial infarction. Compounds 7e, 9a and 11f exhibited % edema inhibition (43.87-54.31) compared to celecoxib (54.17%17 %) at the same time. Histopathological examination of gastric and cardiac tissues proved the safe profiles of compounds 7e and 11 f. The reduction in cardiac biomarkers level (CK-MP, AST, LDH) and the pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β) ensured the cardiac safety of 7e and 11f. Also, RT-PCR results confirmed the efficacy of compounds 7e and 11f to inhibit gene expression of cytokines responsible for the overwhelming inflammation in COVID-19 infection, including TNF-α, IL-6, IL-2 and IL-1β. Additionally, SARS-CoV-2 Mpro inhibitory assay revealed the potency of the compound 7e against Mpro enzyme (IC50 = 13.24 μM). Furthermore, the proper fitting of 7e inside both COX-2 and Mpro active site through the docking study supported the affinity of 7e to inhibit both enzymes. Therefore, a belief stated that compound 7e is a promising lead compound with a safe profile, acting as a selective COX-2 and cytokine inhibitor. Also, 7e reduces the COVID-19 infection's cytokine storm and inhibits viral replication via targeting the Mpro enzyme.

Impact of Severe COVID-19 on Accelerating Dementia Onset: Clinical and Epidemiological Insights

Importance

Severe COVID-19 infection has been associated with neurological complications, but its role in accelerating cognitive decline remains unclear.

Objective

To determine whether individuals hospitalized for severe COVID-19 exhibit a higher incidence of new onset cognitive impairment compared to those hospitalized for other conditions.

Design

A retrospective study emulating a target trial using Mass General Brigham electronic health records (March 2020-August 2024). The causal effect of COVID-19 hospitalization was estimated via cumulative incidence functions accounting for the competing risk of death.

Setting

Multicenter hospital-based study across the Mass General Brigham healthcare system.

Participants

A total of 221613 hospitalized patients met the eligibility criteria, including 6454 (2.0%) admitted due to COVID-19 and 215159 (98.0%) for all other conditions. Patients were excluded if they had less than three months of follow-up (due to censoring, cognitive impairment, or death), were younger than 55 years at baseline, or had no prior visit to Mass General Brigham in the year before baseline.

Main Outcomes and Measures

The primary outcome was new-onset cognitive impairment, identified via ICD codes and dementia medication prescriptions. The primary analysis estimated the hazard ratio for cognitive impairment with COVID-19 hospitalization relative to other hospitalizations, along with the risk difference at 4.5 years estimated via cumulative incidence functions. Inverse propensity score weighting was used to balance covariates (age, sex, comorbidities, hospitalization period).

Results

Among eligible patients (mean [SD] age, 69.55 [9.42] years, 55% female), those hospitalized for COVID-19 were significantly older and had more comorbidities (p < 0.05). COVID-19 hospitalization was associated with a higher risk of developing cognitive impairment (Hazard Ratio: 1.14 [95% CI: 1.02-1.30], P = 0.018). At 4.5 years, the cumulative incidence of cognitive impairment was 12.5% [95% CI: 11.3-13.5] in the COVID-19 group, compared to 11.6% [95% CI: 11.1-12.1] in the non-COVID-19 group.

Conclusions and Relevance

Severe COVID-19 infection was associated with an elevated risk of developing clinically recognized cognitive impairment. Future studies are needed to validate findings in other health care settings. Early screening and intervention for cognitive decline may help optimize long-term outcomes for COVID-19 patients.

Cognitive functions in COVID-19 survivors, approaches strategies, and impact on health systems: a qualitative systematic review

Post-COVID syndrome has been defined as signs and symptoms that develop after an infection consistent with COVID-19 and continue for more than 12 weeks, including neurocognitive signs and symptoms that have an impact on the functioning and quality of life of middle-aged adult and older survivors. This systematic review describes the current knowledge of long-term cognitive impairments in COVID-19 survivors, approaches strategies, and their impact on public and private health services worldwide. The systematic review was conducted under the criteria and flowchart established in the PRISMA statement, considering studies from the PubMed, Scopus, and Web of Science databases between 2020 and 2023. The included studies considered participants over 40 years of age, COVID-19 survivors. A total of 68 articles were included, most of which had high to excellent quality. The analysis showed the presence of heterogeneous cognitive symptoms in COVID survivors, persistent for at least 12 weeks from the onset of infection, mostly unsystematized and nonspecific approaches strategies, and a lack of methods for monitoring their effectiveness, with a significant economic and logistical impact on health systems. Specific protocols are required for the rehabilitation of persistent cognitive dysfunction in COVID-19 survivors, as well as longitudinal studies to evaluate the effectiveness of these interventions.

A pilot study comparing the rehabilitation functional outcomes of post-COVID-19 stroke and non-COVID stroke patients: An occupational therapy perspective

Background and purpose: Recent studies have highlighted the clinical characteristics and incidence of post-COVID-19 stroke conditions. Comparing the function and overall prognosis of stroke patients and post-COVID-19 stroke patients is an intriguing idea. Therefore, the aim of this study was to examine and compare the functional outcomes between the two groups from an occupational therapy perspective. Methods: Forty patients admitted to a rehabilitation facility were included, 20 of whom were diagnosed with post-COVID-19 stroke and 20 with non-COVID-19 stroke (ischemic and hemorrhagic). The study was a mixed design consisting of both prospective and retrospective data collection. Existing data from electronic medical records were used for the retrospective dataset. The retrospective dataset only consisted of data from post-COVID-19 stroke patients. The prospective dataset consisted of data from non-COVID-19 stroke patients. Data were collected at the time of admission and at discharge. Outcome measures included the functional independence measure (FIM), the Action Research Arm Test (ARAT), the post-COVID-19 functional status (PCFS) scale, the Borg rating of perceived exertion, and the mini-mental state examination (MMSE). Results: Both the post-COVID-19 stroke and non-COVID stroke groups showed significant differences before and after rehabilitation (NIHSS (National Institutes of Health Stroke Scale): p = 0.014, 0.000, FIM: p = 0.000, 0.000, MMSE: p = 0.015, 0.000, ARAT: p = 0.000, 0.000, respectively). However, the mean difference in the non-COVID-19 stroke group was higher than that in the post-COVID-19 stroke group, particularly in MMSE, FIM, and NIHSS scores (NIHSS: 2.8 ± 0.4, 0.9 ± 0.04, FIM: 34.8 ± 5.03, 32.95 ± 0.81, MMSE: 5.05 ± 3.5, 0.7 ± 1.17, ARAT: 1 ± 0.062, 1.2 ± 0.47, respectively). It was also found that in the post-COVID-19 stroke group, age had a positive influence on NIHSS (p = 0.022) and FIM (p = 0.047), and impaired side affected the NIHSS scores (p = 0.007). In the non-COVID-19 stroke group, significant correlations were found between the NIHSS and FIM scores (r = -0.445, p = 0.050) and the NIHSS and ARAT scores (r = -0.529, p = 0.017). Conclusion: Higher mean differences in the non-COVID-19 stroke group than in the post-COVID-19 group could be due to additional COVID-19 complications in the stroke condition itself. Overall functional gain was observed in both groups due to the effective rehabilitation. Therefore, rehabilitation is critical for functional optimization in such vulnerable populations. There is an urgent need to consider post-pandemic rehabilitation aspects.

Association between COVID-19 infection and new-onset dementia in older adults: a systematic review and meta-analysis

BACKGROUND

The relationship between COVID-19 infection and a possible increased likelihood of older adults developing new-onset dementia (NOD) remains elusive.

METHODS

A thorough search was performed across several databases including MEDLINE/PubMed, PsycINFO, Scopus, medRxiv, and PQDT Global for studies published in English from January 2020 to December 2023. Only original investigations exploring the link between COVID-19 infection and NOD were selected for inclusion. We assessed the risk of developing NOD, using Risk Ratio (RR) for measurement. Control groups were categorized as: (i) a non-COVID cohort with other respiratory infections [control group (C1)]; and (ii) a non-COVID cohort with otherwise unspecified health status [control group (C2)]. Follow-up periods were divided into intervals of 3, 6, 12, and 24 months post-COVID.

RESULTS

11 studies (involving 939,824 post-COVID-19 survivors and 6,765,117 controls) were included in the review. Across a median observation period of 12 months post-COVID, the overall incidence of NOD was about 1.82% in the COVID-infected group, compared to 0.35% in the non-COVID-infected group. The overall pooled meta-analysis showed a significantly increased NOD risk among COVID-19 older adult survivors compared to non-COVID-19 controls (RR = 1.58, 95% CI 1.21-2.08). Similar increased NOD risks were observed in subgroup analyses restricted to an observational period of 12 months (RR = 1.56, 95% CI 1.21-2.01), as well as in five studies that employed propensity score matching to sufficiently and effectively control for multiple confounding covariates (RR = 1.46, 95% CI 1.10-1.94). COVID-19 group and C1 group shared a comparably increased risk of developing NOD (overall RR = 1.13, 95% CI 0.92-1.38).

DISCUSSION

Under normal circumstances, we believe that COVID-19 infection is likely to be a risk factor for developing NOD in older adults over time. While the increased NOD risk due to COVID-19 infection appears to be similar to that associated with other respiratory infections, it warrants and necessitates investigation with longer observations.

The risk of cognitive decline and dementia in older adults diagnosed with COVID-19: A systematic review and meta-analysis

BACKGROUND

Cognitive impairment can be caused by infections with various pathogens, including SARS-CoV-2. Research has yet to determine the true incidence and course of cognitive impairment in older adults following COVID-19. Furthermore, research has theorised that COVID-19 is associated with dementia progression and diagnosis but this association has yet to be fully described.

METHODS

A systematic review was registered in Prospero and conducted on the databases PubMed, Embase, Ovid, CENTRAL and Cochrane Library. Studies reporting cognitive impairment and dementia outcomes in post-acute and post-COVID-19 patients aged ≥65 years, and which included control data, were included in this review.

RESULTS

15,124 articles were identified by the search strategy. After eliminating duplicate titles and completing title, abstracts and full-text review, 18 studies were included comprising of 412,957 patients with COVID-19 (46.63 % male) and 411,929 patients without COVID-19 (46.59 % male). The overall mean Montreal Cognitive Assessment (MoCA) score in COVID-19 patients was 23.34 out of 30 (95 % CI [22.24, 24.43]). indicating cognitive impairment. The overall proportion of patients identified as having new onset cognitive impairment was 65 % (95 % CI [44,81]). Subgroup analyses indicated that time since infection significantly improves overall MoCA score and reduces proportion of patients with cognitive impairment.

CONCLUSION

This study indicates that cognitive impairment may be an important sequela of COVID-19. Further research with adequate sample sizes is warranted regarding COVID-19's association with new-onset dementia and dementia progression, and the effect of repeat infections. There is a need for development of diagnostic and management protocols for COVID-19 patients with cognitive impairment.

Memory complaints after COVID-19: a potential indicator of primary cognitive impairment or a correlate of psychiatric symptoms?

Cognitive impairment and symptoms of psychiatric disorders have been reported frequently as features of post-acute sequelae of SARS-CoV-2 infection. This study aims to investigate subjective memory complaints in COVID-19 survivors and determine if these are more strongly associated with objective cognitive impairment related to sequelae of SARS-CoV-2 infection or with symptoms of psychiatric conditions. A total of 608 COVID-19 survivors were evaluated in-person 6-11 months after hospitalization, with 377 patients assigned to a "no subjective memory complaint (SMC)" group and 231 patients assigned to an SMC group based on their Memory Complaint Scale scores. Follow-up evaluations included an objective cognitive battery and scale-based assessments of anxiety, depression, and post-traumatic stress symptoms. We found the perception of memory impairment in COVID-19 survivors to be more strongly associated to core symptoms of psychiatric conditions rather than to primary objective cognitive impairment. Univariate analysis indicated significant differences between the "no SMC" and SMC groups, both for the psychiatric symptom evaluations and for the cognitive evaluations (p < 0.05); however, the psychiatric symptoms all had large partial eta-squared values (ranging from 0.181 to 0.213), whereas the cognitive variables had small/medium partial eta-squared values (ranging from 0.002 to 0.024). Additionally, multiple regression analysis indicated that only female sex and depressive and post-traumatic stress symptoms were predictors of subjective memory complaints. These findings may help guide clinical evaluations for COVID-19 survivors presenting with memory complaints while also serving to expand our growing understanding of the relationship between COVID-19, subjective memory complaints, and the risk of cognitive decline.

Analyzing public discourse of dementia from Spanish and English tweets: a comparative analysis with other neurological disorders

Introduction

Dementia comprise a broad spectrum of cognitive declines affecting 47 million people worldwide, with numbers projected to reach 131 million by 2050. Predominantly associated with older adults, dementia can also impact younger individuals, having a significant impact on daily functioning of the affected patients, relatives, caregivers and the socioeconomic system. Recent research underscores the utility of social media, particularly X (previously designed as Twitter), in understanding public perceptions and sentiments related to neurological disorders. Despite some initial studies have explored social perceptions of dementia in X, broader and deeper analysis of this condition is still warranted.

Materials and methods

In this retrospective study, we collected and examined all tweets posted in English or Spanish from 2007 to 2023 that mentioned dementia and compare the information with other highly representative neurological disorders like migraines, epilepsy, multiple sclerosis, spinal cord injury, or Parkinson's disease. We developed a codebook to analyze tweets, classifying them by themes such as trivialization, treatment perceptions, and etiopathogenesis. Manually categorized tweets trained machine learning models, BERTWEET for English and BETO for Spanish, which then classified larger datasets with high accuracy. Statistical analysis, including ANOVA, Kruskal-Wallis, and chi-square tests, was conducted to explore linguistic and cultural differences in perceptions of neurological disorders, with results visualized.

Results

Our study reveals that dementia is by far the most frequently discussed neurological disorder on X. Likewise, this condition appears to be the most trivialized neurological disorder in Spanish tweets and the second most trivialized in English tweets, with notable differences in geolocation data. Additionally, we found significant differences in perceptions of dementia treatment and associated sentiments between Spanish and English tweets. Furthermore, our study identified varying perceptions of medical content (etiology) and non-medical content (positive/negative experiences and aid requests) related to dementia and other neurological disorders, unveiling a complex landscape of these topics on X.

Conclusions

This study explores the importance of X as a social platform for addressing various critical issues related to dementia, comparing it with other neurological disorders in English and Spanish tweets. Future research could further investigate the valuable role of social media in understanding public perceptions and needs regarding dementia and neurological disorders among X users.

Forecasted Dementia Prevalence in Portugal (2020-2080)

Dementia is a global public health challenge, and its impact on Portugal is yet unclear. This study forecasts dementia prevalence in Portugal until 2080. Using the Gonçalves-Pereira et al (2021) method, we estimated dementia cases among older adults (≥65 years) in the community. Applying age-sex specific prevalence rates of the Gonçalves-Pereira study to population projections for Portugal between 2020-2080, based on the 10/66 Dementia Research Group criteria (10/66 DRG) and the Diagnostic and Statistical Manual of Mental Disorders IV criteria (DSM-IV), to Portugal's population projections (2020-2080) under various growth scenarios (low, medium, and high). We anticipate a more than 2-fold increase in dementia prevalence from 2020 to 2080, both for 10/66 DRG [2.1%-5.0%] and DSM-IV [.8%-2.0%]. By 2080, those aged ≥80 years are projected to constitute 75.0% (vs 59.0% in 2020) of all dementia cases, particularly affecting women. Addressing dementia growth in Portugal calls for a comprehensive global response, while country-level estimates facilitate informed public health planning, policy-making, and resource allocation.

Coronavirus disease 2019 and its impact on the cognition of older adults: Unraveling the role of inflammation

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic significantly impacted the older adult population globally. This study aimed to investigate cognitive function and its relationship with inflammation in older COVID-19 survivors over a three-month follow-up to address concerns about cognitive impairment and its risk factors.

METHODS

In this descriptive-analytical study, 177 hospitalized COVID-19 patients aged >60 were assessed from July 2021 to February 2022. Psychiatric, global cognitive assessments and activities of daily living were conducted at discharge, 1 month, and 3 months post-discharge. Statistical analyses were conducted using SPSS Version 24. The evolution of cognitive status over time was evaluated using the Repeated Measures Test. The study probed into the association between inflammatory markers and cognitive function through the Pearson correlation test and the Mann-Whitney U test. Additionally, the link between anxiety/depression and cognitive performance was examined using the Pearson correlation.

RESULTS

Results indicated that higher levels of C-reactive protein (CRP), D-dimer, and Lactate Dehydrogenase (LDH) were correlated to reduced cognitive performance. Conversely, Erythrocyte Sedimentation Rate (ESR) and Creatine Phosphokinase (CPK) did not exhibit a significant relationship with cognitive scores. A positive correlation was observed between improved cognitive function (reflected by higher GPCOG scores) and lower levels of anxiety and depression (indicated by lower scores on the Hospital Anxiety and Depression Scale). Over the study period, cognitive function and anxiety scores showed an upward trend, whereas symptoms of depression and challenges in daily activities remained consistent.

CONCLUSIONS

The study highlights the enduring effects and detrimental role of inflammation on overall cognitive abilities among older survivors of COVID-19. It underscores the urgent need for specialized interventions and rehabilitative strategies to facilitate sustained cognitive recuperation among these individuals.

Development of a prediction model of conversion to Alzheimer's disease in people with mild cognitive impairment: the statistical analysis plan of the INTERCEPTOR project

BACKGROUND

In recent years, significant efforts have been directed towards the research and development of disease-modifying therapies for dementia. These drugs focus on prodromal (mild cognitive impairment, MCI) and/or early stages of Alzheimer's disease (AD). Literature evidence indicates that a considerable proportion of individuals with MCI do not progress to dementia. Identifying individuals at higher risk of developing dementia is essential for appropriate management, including the prescription of new disease-modifying therapies expected to become available in clinical practice in the near future.

METHODS

The ongoing INTERCEPTOR study is a multicenter, longitudinal, interventional, non-therapeutic cohort study designed to enroll 500 individuals with MCI aged 50-85 years. The primary aim is to identify a biomarker or a set of biomarkers able to accurately predict the conversion from MCI to AD dementia within 3 years of follow-up. The biomarkers investigated in this study are neuropsychological tests (mini-mental state examination (MMSE) and delayed free recall), brain glucose metabolism ([18F]FDG-PET), MRI volumetry of the hippocampus, EEG brain connectivity, cerebrospinal fluid (CSF) markers (p-tau, t-tau, Aβ1-42, Aβ1-42/1-40 ratio, Aβ1-42/p-Tau ratio) and APOE genotype. The baseline visit includes a full cognitive and neuropsychological evaluation, as well as the collection of clinical and socio-demographic information. Prognostic models will be developed using Cox regression, incorporating individual characteristics and biomarkers through stepwise selection. Model performance will be evaluated in terms of discrimination and calibration and subjected to internal validation using the bootstrapping procedure. The final model will be visually represented as a nomogram.

DISCUSSION

This paper contains a detailed description of the statistical analysis plan to ensure the reproducibility and transparency of the analysis. The prognostic model developed in this study aims to identify the population with MCI at higher risk of developing AD dementia, potentially eligible for drug prescriptions. The nomogram could provide a valuable tool for clinicians for risk stratification and early treatment decisions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03834402. Registered on February 8, 2019.

An Integrative Approach to the Study of Cognitive Abilities in a Non-Human Primate Model in a Virology Laboratory Environment

Non-human primates, due to their similarities in immune response to humans, are the preferred model for studying infectious processes and any associated cognitive impairments. Behavioral tests are indispensable for investigating pathogenesis in neuroinfections, especially those that do not manifest with noticeable clinical symptoms, as well as in the transition to a chronic form of the disease. Modeling viral infection requires specialized experimental conditions. Our work describes techniques for investigating mnemonic functions, tiredness, attentional focus, quick-wittedness, and basic behavioral responses in primates under the assumed conditions for infections with viruses that do not have an airborne route of transmission. It also outlines approaches to the training and selection of primates for virological research, as well as analyzing gender differences in learning abilities, the impact of housing conditions on the results, and the correlation between training success and behavioral test scores. These methods will allow a more detailed study of non-human primates as a model for researching cognitive and behavioral impairments under infectious and immune stress, as well as the design of less energy-intensive experiments for evaluating the efficacy and safety of therapeutic and prophylactic strategies at early stages of infection.

Chlamydia pneumoniae in Alzheimer's disease pathology

While recent advances in diagnostics and therapeutics offer promising new approaches for Alzheimer's disease (AD) diagnosis and treatment, there is still an unmet need for an effective remedy, suggesting new avenues of research are required. Besides many plausible etiologies for AD pathogenesis, mounting evidence supports a possible role for microbial infections. Various microbes have been identified in the postmortem brain tissues of human AD patients. Among bacterial pathogens in AD, Chlamydia pneumoniae (Cp) has been well characterized in human AD brains and is a leading candidate for an infectious involvement. However, no definitive studies have been performed proving or disproving Cp's role as a causative or accelerating agent in AD pathology and cognitive decline. In this review, we discuss recent updates for the role of Cp in human AD brains as well as experimental models of AD. Furthermore, based on the current literature, we have compiled a list of potential mechanistic pathways which may connect Cp with AD pathology.

COVID-19 and Alzheimer's disease: Impact of lockdown and other restrictive measures during the COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection initially results in respiratory distress symptoms but can also lead to central nervous system (CNS) and neurological manifestations, significantly impacting coronavirus disease 2019 (COVID-19) patients with neurodegenerative diseases. Additionally, strict lockdown measures introduced to curtail the spread of COVID-19 have raised concerns over the wellbeing of patients with dementia and/or Alzheimer's disease. The aim of this review was to discuss the overlapping molecular pathologies and the potential bidirectional relationship between COVID-19 and Alzheimer's dementia, as well as the impact of lockdown/restriction measures on the neuropsychiatric symptoms (NPS) of patients with Alzheimer's dementia. Furthermore, we aimed to assess the impact of lockdown measures on the NPS of caregivers, exploring its potential effects on the quality and extent of care they provide to dementia patients.We utilized the PubMed and Google Scholar databases to search for articles on COVID-19, dementia, Alzheimer's disease, lockdown, and caregivers. Our review highlights that patients with Alzheimer's disease face an increased risk of COVID-19 infection and complications. Additionally, these patients are likely to experience greater cognitive decline. It appears that these issues are primarily caused by the SARS-CoV-2 infection and appear to be further exacerbated by restrictive/lockdown measures. Moreover, lockdown measures introduced during the pandemic have negatively impacted both the NPSs of caregivers and their perception of the wellbeing of their Alzheimer's patients. Thus, additional safeguard measures, along with pharmacological and non-pharmacological approaches, are needed to protect the wellbeing of dementia patients and their caregivers in light of this and possible future pandemics.

[Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]

An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.

Characteristics of long COVID and the impact of COVID-19 vaccination on long COVID 2 years following COVID-19 infection: prospective cohort study

This prospective cohort study aimed to identify characteristics of long COVID and any potential mitigating effects of COVID-19 vaccinations in patients 24 months following COVID-19 infection. Adult patients diagnosed with COVID-19 between February 17, 2020, and March 24, 2020, were scheduled to visit the study hospital four times (6, 12, 18, and 24 months after infection) to assess their symptoms, quality of life, and mental health. Among the 235 patients, 121 (51.5%) completed the study visits. Of these, 59.5% were female, with a median age of 52 years. Mild to moderate disease severity were identified in 101 (83.4%) patients. A total of 75 participants (62.0%) were still experiencing long COVID symptoms 24 months after acute infection. Fatigue, amnesia, difficulty concentrating, and insomnia were the most common symptoms. The frequency of neuropsychiatric symptoms did not differ based on vaccination status or the number of doses received. Quality of life improved over time for the participants, but 32.2% of respondents still reported anxiety/depression at the end of the study. Overall, our cohort demonstrates that long COVID can persist up to 24 months after COVID-19 infection, affecting mental health and quality of life.

Relationship between COVID-19 and Neurological Disorder

Abstract:

The COVID-19 pandemic has resulted in a socially isolating way of life, and dementia patients are among those who are most affected. Lockdown procedures and the inability to monitor illnesses have led to a rapid decline in cognitive function in these individuals, with neuropsychiatric symptoms, such as agitation, delirium, and impaired motor performance being prevalent. However, the use of antipsychotics in treating these symptoms can increase the risk of death during COVID-19. Effective pain therapy can be used as an alternative to reduce or avoid the use of antipsychotics, given the consistent relationship between agitation and pain in dementia patients. The importance of properly assessing and managing pain in dementia patients is highlighted. Additionally, the article discusses how COVID-19 can affect brain health through inflammation, blood clotting, and blood vessel damage, leading to potential long-term effects on cognitive function. Healthcare professionals must be aware of the increased risk of neuropsychiatric symptoms in dementia patients during the pandemic and prioritize pain management as a viable alternative to antipsychotics. Proper care and attention are necessary to prevent cognitive decline and potential long-term effects on brain health in these vulnerable individuals.

Use of either transcranial or whole-body photobiomodulation treatments improves COVID-19 brain fog

There is increasing recognition of post-COVID-19 sequelae involving chronic fatigue and brain fog, for which photobiomodulation (PBM) therapy has been utilized. This open-label, pilot, human clinical study examined the efficacy of two PBM devices, for example, a helmet (1070 nm) for transcranial (tPBM) and a light bed (660 and 850 nm) for whole body (wbPBM), over a 4-week period, with 12 treatments for two separate groups (n = 7 per group). Subjects were evaluated with a neuropsychological test battery, including the Montreal Cognitive Assessment (MoCA), the digit symbol substitution test (DSST), the trail-making tests A and B, the physical reaction time (PRT), and a quantitative electroencephalography system (WAVi), both pre- and post- the treatment series. Each device for PBM delivery was associated with significant improvements in cognitive tests (p < 0.05 and beyond). Changes in WAVi supported the findings. This study outlines the benefits of utilizing PBM therapy (transcranial or whole-body) to help treat long-COVID brain fog.

Impact of discontinuing non-pharmacological interventions on cognitive impairment in dementia patients by COVID-19 lockdown. A pilot observational, longitudinal, retrospective study carried out in an adult day center in Spain during the COVID-19 pandemic

Background

The lockdown imposed during the COVID-19 pandemic led to social isolation and prevented patients with dementia from receiving a suite of non-pharmacological interventions (NPIs) that prevent cognitive decline. This discontinuation of NPIs could substantially affect the mental health status of people with dementia in social care settings, such as adult day care centers (ADCs).

Propose

The study aimed to evaluate the effects of the COVID-19 lockdown on mental health and cognitive impairment in patients with dementia who could not attend their usual ADCs and did not receive our NPIs, based on World Health Organization (WHO) Guidelines.

Methods

Observational, longitudinal, retrospective study carried out in an adult day center in Spain and reported it in accordance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) in 80 patients attending the ADC of the "Leonese Association of Dementia Patients" (León, Spain), who had been evaluated with this instrument before the COVID-19 lockdown.

Results

We observed a 0.4-point decrease in MMSE score/month (IQR = 1.4) during lockdown versus a 0.1-point decrease/month (IQR = 0.3) before this period (p = 0.038). Notably, this translated to >10-point decreases in MMSE score/year in 33.8% of participants during lockdown versus 5.5% earlier (p < 0.001). No statistically significant associations (p < 0.05) were found between the individual characteristics of the caregivers and the occurrence of the event.

Conclusion

The reported declines in MMSE scores reveal a significant acceleration of cognitive decline during the period of inactivity. This could suggest that our NPIs, focused on slowing cognitive decline, are beneficial and, therefore, necessary in patients with dementia.

Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms

Numerous investigations have demonstrated significant and long-lasting neurological manifestations of COVID-19. It has been suggested that as many as four out of five patients who sustained COVID-19 will show one or several neurological symptoms that can last months after the infection has run its course. Neurological symptoms are most common in people who are less than 60 years of age, while encephalopathy is more common in those over 60. Biological mechanisms for these neurological symptoms need to be investigated and may include both direct and indirect effects of the virus on the brain and spinal cord. Individuals with Alzheimer's disease (AD) and related dementia, as well as persons with Down syndrome (DS), are especially vulnerable to COVID-19, but the biological reasons for this are not clear. Investigating the neurological consequences of COVID-19 is an urgent emerging medical need, since close to 700 million people worldwide have now had COVID-19 at least once. It is likely that there will be a new burden on healthcare and the economy dealing with the long-term neurological consequences of severe SARS-CoV-2 infections and long COVID, even in younger generations. Interestingly, neurological symptoms after an acute infection are strikingly similar to the symptoms observed after a mild traumatic brain injury (mTBI) or concussion, including dizziness, balance issues, anosmia, and headaches. The possible convergence of biological pathways involved in both will be discussed. The current review is focused on the most commonly described neurological symptoms, as well as the possible molecular mechanisms involved.

Exploring the dual effect of novel 1,4-diarylpyranopyrazoles as antiviral and anti-inflammatory for the management of SARS-CoV-2 and associated inflammatory symptoms

COVID-19 and associated substantial inflammations continue to threaten humankind triggering death worldwide. So, the development of new effective antiviral and anti-inflammatory medications is a major scientific goal. Pyranopyrazoles have occupied a crucial position in medicinal chemistry because of their biological importance. Here, we report the design and synthesis of a series of sixteen pyranopyrazole derivatives substituted with two aryl groups at N-1 and C-4. The designed compounds are suggested to show dual activity to combat the emerging Coronaviruses and associated substantial inflammations. All compounds were evaluated for their in vitro antiviral activity and cytotoxicity against SARS-CoV infected Vero cells. As well, the in vitro assay of all derivatives against the SARS-CoV M^pro target was performed. Results revealed the potential of three pyranopyrazoles (22, 27, and 31) to potently inhibit the viral main protease with IC₅₀ values of 2.01, 1.83, and 4.60 μM respectively compared with 12.85 and 82.17 μM for GC-376 and lopinavir. Additionally, in vivo anti-inflammatory testing for the most active compound 27 proved its ability to reduce levels of two cytokines (TNF-α and IL-6). Molecular docking and dynamics simulation revealed consistent results with the in vitro enzymatic assay and indicated the stability of the putative complex of 27 with SARS-CoV-2 M^pro. The assessment of metabolic stability and physicochemical properties of 27 have also been conducted. This investigation identified a set of metabolically stable pyranopyrazoles as effective anti-SARS-CoV-2 M^pro and suppressors of host cell cytokine release. We believe that the new compounds deserve further chemical optimization and evaluation for COVID-19 treatment.

COVID-19-related psychiatric manifestations requiring hospitalization: Analysis in older vs. younger patients

The complex manifestations of COVID-19 include psychiatric symptoms, having multifaceted profiles with varying severity during the acute phase and further during the recovery period. Limited data exist which have analyzed whether there are any age-related differences. A study lot of 89 COVID-19 patients with mild-to-moderate SARS-CoV-2 infection requiring hospitalization for mental issues provided comparative data from two age groups below and above 60 years. The majority of patients had new onset of a mental issue during COVID-19, 24.7% of the total lot being diagnosed with depressive disorder. The senior patient set had a significantly higher prevalence of sleep disorder vs. the younger study group (53.3 vs. 28.8%), depression (33.3 vs. 10.2%) and cognitive impairment (26.7 vs. 8.5%), while patients <60 years of age had a higher prevalence of hallucinations, delirium and bizarre behavior. Psychiatric manifestations are an important part of the symptomatology of COVID-19, sometimes requiring hospitalization. Age-related neuropsychiatric substrate could explain some of these differences between the two study subgroups. Further data are needed to complete the acute and long-term distinctive profiles of COVID-19-related mental illness in older and younger patients.

Prevention of HBV Reactivation in Hemato-Oncologic Setting during COVID-19

Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, frequently develop COVID-19 due to the immunosuppression caused by tumor growth, chemotherapy and immunosuppressive therapy. In addition, COVID-19 has also been recognized as a further cause of HBV reactivation, since its treatment includes the administration of corticosteroids and some immunosuppressive drugs. Consequently, onco-hematologic patients should undergo SARS-CoV-2 vaccination and comply with the rules imposed by lockdowns or other forms of social distancing. Furthermore, onco-hematologic facilities should be adapted to new needs and provided with numerically adequate health personnel vaccinated against SARS-CoV-2 infection. Onco-hematologic patients, both HBsAg-positive and HBsAg-negative/HBcAb-positive, may develop HBV reactivation, made possible by the support of the covalently closed circular DNA (cccDNA) persisting in the hepatocytic nuclei of patients with an ongoing or past HBV infection. This occurrence must be prevented by administering high genetic barrier HBV nucleo(t)side analogues before and throughout the antineoplastic treatment, and then during a long-term post-treatment follow up. The prevention of HBV reactivation during the SARS-CoV-2 pandemic is the topic of this narrative review.

Higher Inflammatory Markers are correlated with Worse Cognitive Function in Coronavirus Disease-2019 Patients

AIM: This study aimed to determine the correlation between inflammation with cognitive function in COVID-19 patients. METHODS: We recruited COVID-19 patients using consecutive sampling methods in Adam Malik General Hospital Medan, Indonesia. The neutrophil-to-lymphocyte ratio (NLR,) C-reactive protein (CRP), D-dimer, and ferritin serum levels were measured as inflammatory markers . Cognitive function was assessed in several cognitive domains using Forward Digit Span for attention, Bacward Digit Span for working memory, and Trail Making Test parts A and B for executive function. The correlation between inflammatory markers and cognitive function was analyzed using Spearman correlation test. RESULTS: This study involved 40 COVID-19 patients consisting of 13 (32.5%) males and 27 (67.5%) females; the median age of the patients was 39.5 (19–65) years. We found that higher D-dimer and ferritin levels were significantly correlated with worse BDS scores (r = −0.369 p = 0.019 and r = −0.408 p = 0.009, respectively) and higher ferritin level was also correlated with worse FDS score (r = −0.365 p = 0.020 and). Higher D-dimer and ferritin levels were also significantly correlated with a longer time of completion of TMT-B (r = 0.363 p = 0.022 and r = 0.433 p = 0.005) and higher ferritin level was also correlated with a longer time of completion of TMT-A (r = 0.438 P=0.005). There were no significant correlations between NLR and CRP levels with cognitive function. CONCLUSION: Higher inflammatory markers are correlated with worse attention, working memory, and executive function in COVID-19 patients.

Can SARS-CoV-2 Infection Exacerbate Alzheimer's Disease? An Overview of Shared Risk Factors and Pathogenetic Mechanisms

The current coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV)-2, is affecting every aspect of global society, including public healthcare systems, medical care access, and the economy. Although the respiratory tract is primarily affected by SARS-CoV-2, emerging evidence suggests that the virus may also reach the central nervous system (CNS), leading to several neurological issues. In particular, people with a diagnosis of Alzheimer's disease (AD) are a vulnerable group at high risk of contracting COVID-19, and develop more severe forms and worse outcomes, including death. Therefore, understanding shared links between COVID-19 and AD could aid the development of therapeutic strategies against both. Herein, we reviewed common risk factors and potential pathogenetic mechanisms that might contribute to the acceleration of neurodegenerative processes in AD patients infected by SARS-CoV-2.