Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study

Background

COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing.

Methods

To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK.

Findings

We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention.

Interpretation

Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC.

Funding

Wellcome Trust (206330/Z/17/Z), NIHR Oxford Health Biomedical Research Centre, the Thüringer Aufbaubank (2021 FGI 0060), German Forschungsgemeinschaft (DFG, FI 1424/2-1) and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890).

Characterization of neurocognitive deficits in patients with post-COVID-19 syndrome: persistence, patients' complaints, and clinical predictors

Introduction

Cognitive symptoms persisting beyond 3 months following COVID-19 present a considerable disease burden. We aimed to establish a domain-specific cognitive profile of post-COVID-19 syndrome (PCS). We examined the deficits' persistence, relationships with subjective cognitive complaints, and clinical variables, to identify the most relevant cognitive deficits and their predictors.

Methods

This cross-sectional study examined cognitive performance and patient-reported and clinical predictors of cognitive deficits in PCS patients (n = 282) and socio-demographically comparable healthy controls (n = 52).

Results

On the Oxford Cognitive Screen-Plus, the patient group scored significantly lower in delayed verbal memory, attention, and executive functioning than the healthy group. In each affected domain, 10 to 20% of patients performed more than 1.5 SD below the control mean. Delayed memory was particularly affected, with a small effect of hospitalization and age. Attention scores were predicted by hospitalization and fatigue.

Discussion

Thus, PCS is associated with long-term cognitive dysfunction, particularly in delayed memory, attention, and executive functioning. Memory deficits seem to be of particular relevance to patients' experience of subjective impairment. Hospitalization, fatigue, and age seem to predict cognitive deficits, while time since infection, depression, and pre-existing conditions do not.

Association between antenatal glucocorticoid exposure and the activity of the stress system, cognition, and behavior in 8- to 9-year-old children: A prospective observational study

INTRODUCTION

Glucocorticoid (GC) -induced fetal programming of the activity of the hypothalamus-pituitary-adrenal axis (HPAA) and its associated cognitive and behavioral consequences in later life have been well characterized in several animal species. However, information on humans is scarce. In this study, we examined HPAA activity markers and associated outcomes at 8 to 9 years of age among children prenatally exposed to GC for suspected preterm birth. Our hypothesis was that antenatal exposure to the betamethasone (BM) is associated with exacerbation of HPAA activity in childhood.

MATERIAL AND METHODS

Prospective observational study in 31 children whose mothers received single (n = 19) or multiple (n = 12) courses of BM for threatened preterm birth but born with normal weight appropriate for the gestational age (median 37+⁶  weeks of gestation) compared with 38 non-exposed, age-matched children. Primary end point was the activity of the HPAA in response to the Trier Social Stress Test. Secondary end points were changes in autonomic nervous system (ANS) activity, cognitive performance (IQ), attention-deficit/hyperactivity disorder (ADHD) symptoms, and electrocortical activity (EEG).

RESULTS

There was no statistically significant difference in HPAA activity markers between antenatal BM exposed and unexposed groups. ANS activity in BM-exposed children shifted towards a higher parasympathetic tone reflected by a higher overall high-frequency band power of heart rate variability. IQ scores were within normal limits for both groups; however, BM-exposed children had lower IQ scores than the unexposed group. BM-exposed group had marginally more ADHD core symptoms and increased electrocortical activity in the occipital brain region compared with controls. A monotonic dose-response relationship between BM exposure and activity of the ANS and IQ was estimated in post-hoc analyses.

CONCLUSIONS

Antenatal exposure to BM in the context of threatened preterm birth was not associated with changes in HPAA activity in childhood. However, BM exposure may be associated with changes in ANS activity. Antenatal GC prophylaxis is a valuable and often life-saving therapy, but its prescription may warrant a well-balanced risk-benefit assessment.

Protocol for a Cross-Sectional Study: Effects of a Multiple Sclerosis Relapse Therapy With Methylprednisolone on Offspring Neurocognitive Development and Behavior (MS-Children)

Introduction

Multiple Sclerosis (MS) is the most common neuroimmunological disease in women of childbearing age. Current MS therapy consists of immunomodulatory relapse prevention with disease-modifying therapies (DMTs) and acute relapse therapy with the synthetic glucocorticoid (GC) methylprednisolone (MP). As most DMTs are not approved for use during pregnancy, treatment is usually discontinued, increasing the risk for relapses. While MP therapy during pregnancy is considered relatively save for the fetus, it may be detrimental for later cognitive and neuropsychiatric function. The underlying mechanism is thought to be an epigenetically mediated desensitization of GC receptors, the subsequent increase in stress sensitivity, and a GC-mediated impairment of brain development. The aim of this study is to investigate the associations of fetal MP exposure in the context of MS relapse therapy with later cognitive function, brain development, stress sensitivity, and behavior.

Methods and Analysis

Eighty children aged 8–18 years of mothers with MS will be recruited. Forty children, exposed to GC in utero will be compared to 40 children without fetal GC exposure. The intelligence quotient will serve as primary outcome. Secondary outcomes will include attention, motor development, emotional excitability, Attention-Deficit Hyperactivity Disorder-related symptoms, and behavioral difficulties. The Trier Social Stress Test will test stress sensitivity, EEG and MRI will assess functional and structural brain development. To determine underlying mechanisms, DNA methylation of the GC receptor gene and the H19/IGF2 locus and changes in the microbiome and the metabolome will be investigated. Primary and secondary outcomes will be analyzed using linear regression models. Time-variant outcomes of the stress test will be analyzed in two mixed linear models exploring overall activity and change from baseline.

Ethics and Dissemination

This study was approved by the participating institutions' ethics committees and results will be presented in accordance with the STROBE 2007 Statement.

Trial Registration

https://clinicaltrials.gov/ct2/show/NCT04832269?id=ZKSJ0130

Validation of an automated scoring program for a digital complex figure copy task within healthy aging and stroke

OBJECTIVE

Complex Figure Copy Tasks are one of the most commonly employed neuropsychological tests. However, manual scoring of this test is time-consuming, requires training, and can then still be inconsistent between different examiners. We aimed to develop and evaluate a novel, automated method for scoring a tablet-based Figure Copy Task.

METHOD

A cohort of 261 healthy adults and 203 stroke survivors completed the digital Oxford Cognitive Screen-Plus (OCS-Plus) Figure Copy Task. Responses were independently scored by two trained human raters and by a novel automated scoring program.

RESULTS

Overall, the Automated Scoring Program was able to reliably extract and identify the separate figure elements (average sensitivity and specificity of 92.10% and 90.20%, respectively) and assigned total scores which agreed well with manual scores (intraclass correlation coefficient [ICC] = .83). Receiver Operating Curve analysis demonstrated that, compared to overall impairment categorizations based on manual scores, the Automated Scoring Program had an overall sensitivity and specificity of 80% and 93.40%, respectively (Area Under the Curve; AUC = 86.70%). Automated total scores also reliably distinguished between different clinical impairment groups with subacute stroke survivors scoring significantly worse than longer-term survivors, which in turn scored worse than neurologically healthy adults.

CONCLUSIONS

These results demonstrate that the novel Automated Scoring Program was able to reliably extract and accurately score Figure Copy Task data, even in cases where drawings were highly distorted due to comorbid fine-motor deficits. This represents a significant advancement as this novel technology can be employed to produce immediate, unbiased, and reproducible scores for Figure Copy Task responses in clinical and research environments. Key Points-Question: We aimed to develop and evaluate a novel, automated method for scoring a tablet-based Figure Copy Task.

FINDINGS

The novel Automated Scoring Program was able to reliably extract and accurately score Figure Copy Task data, even in cases where drawings were highly distorted due to comorbid fine-motor deficits.

IMPORTANCE

This represents a significant advancement as this novel technology can be employed to produce immediate, unbiased, and reproducible scores for Figure Copy Task responses in clinical and research environments. Next Steps: Trialing the Automated Scoring Program in clinical environments. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Probability-driven 3D pharmacophore mapping of antimycobacterial potential of hybrid molecules combining phenylcarbamoyloxy and N-arylpiperazine fragments

The current study examines in silico characterization of the structure-inhibitory potency for a set of phenylcarbamic acid derivatives containing an N-arylpiperazine scaffold, considering the electronic, steric and lipophilic properties. The main objective of the ligand-based modelling was the systematic study of classical comparative molecular field analysis (CoMFA)/comparative molecular surface analysis (CoMSA) performance for the modelling of in vitro efficiency observed for these phenylcarbamates, revealing their inhibitory activities against a virulent Mycobacterium tuberculosis H₃₇R_v strain. We compared the findings of efficiency modelling produced by a standard 3D methodology (CoMFA) and its neural counterparts (CoMSA) regarding multiple training/test subsets and variables used. Moreover, systematic space inspection, splitting values into the analysed training/test subsets, was performed to monitor statistical estimator performance while mapping the probability-driven pharmacophore pattern. Consequently, a 'pseudo-consensus' 3D-quantitative structure-activity relationship (3D-QSAR) approach was applied to retrieve an 'average' pharmacophore hypothesis by the investigation of the most densely populated training/test subpopulations to specify the potentially important factors contributing to the inhibitory activity of phenylcarbamic acid analogues. In addition, examination of descriptor-based similarity with a principal component analysis (PCA) procedure was employed to visualize noticeable variations in the performance of these molecules with respect to their structure and activity profiles.

In silico estimation of basic activity-relevant parameters for a set of drug absorption promoters

Finding a balance between a desired drug's potency and its physicochemical properties that are important for its molecule pharmacokinetic or pharmacodynamics profile is still a challenging issue in rational drug discovery. Quantitative assessment of the lipophilic characteristics of potential drug molecules is indispensable for efficient development of Absorption, Distribution, Metabolism, Excretion, Toxicity-tailored structure-activity models; therefore reliable procedures for deriving log P from molecular structure are desirable. In the current work a range of various software log P predictors for estimation of the numerical lipophilic values for a set of cholic acid derivatives were employed and subsequently cross-compared with the experimental parameters. Thus, the empirical lipophilicity (R_M) was compared with the corresponding log P characteristics calculated using alternative methods for deducing the lipophilic features. The mean values of the selected molecular descriptors that were averaged over the chosen calculation methods (consensus clog P) were subsequently correlated with the R_M parameter. As an additional experiment, the iterative variable elimination partial least squares (IVE-PLS) methodology for an ensemble of descriptors retrieved from Dragon 6.0 software was applied for a set of drug transporters. To investigate the variations within the ensemble of cholic acid derivatives principal component analysis (PCA) and self-organizing neural network (SOM) procedures were used to visualize the major differences in the performance of drug promoters with respect to their lipophilic profile.

Multidimensional (3D/4D-QSAR) probability-guided pharmacophore mapping: investigation of activity profile for a series of drug absorption promoters

A hybrid approach that combines 3D and 4D-QSAR methods based on grid and neural paradigms with automated IVE-PLS procedure was examined to identify the pharmacophore pattern for cholic acid derivatives as potential drug absorption promoters.

Complex-forming organic ligands in cloud-point extraction of metal ions: a review

Cloud-point extraction (CPE), an easy, safe, environmentally friendly, rapid and inexpensive methodology for preconcentration and separation of trace metals from aqueous solutions has recently become an attractive area of research and an alternative to liquid-liquid extraction. Moreover, it provides results comparable to those obtained with other separation techniques and has a greater potential to be explored in improving detection limits and other analytical characteristics over other methods. A few reviews have been published covering different aspects of the CPE procedure and its relevant applications, such as the phenomenon of clouding, the application in the extraction of trace inorganic and organic materials, as well as pesticides and protein substrates from different sources, or incorporation of CPE into an FIA system. This review focuses on general properties of the most frequently used organic ligands in cloud-point extraction and on literature data (from 2000 to 2012) concerning the use of modern techniques in determination of metal ions' content in various materials. The article is divided according to the class of organic ligands to be used in CPE.

Multi-element analysis of mineral and trace elements in medicinal herbs and their infusions

Twelve mineral and trace elements (Al, B, Ba, Fe, Zn, Mn, Mg, K, Na, P, Cu, Sr, and Ca) were determined in the herbs and their infusions consumed for medical purposes in Poland such as chamomile (Matricaria chamomilla L.), peppermint (Mentha xpiperita), melissa (Melissa officinalis), sage (Salvia officinalis), nettle (Urtica dioica), linden (Tilia vulgaris) and St. John's wort (Hypericum calycinum). Dry digestion procedure for total concentration and wet digestion procedure for infusions were applied under optimized conditions for dissolution of medicinal herbs. Element concentrations in herbs and their infusions were determined by ICP-OES. The accuracy and precision were verified against NCS DC 73349 - bush branches and leaves certified reference material. The result of total concentrations of elements in herb leaves shows that all herbs contain most of the elements, except K and P, in the μg/g range, and that elemental concentrations varied widely. Moreover, on the basis of experimental results for the extraction efficiencies, the elements in herb infusions were classified into three specific groups: highly-extractable (>55%) including K; moderately-extractable (20-55%) including Mg, Na, P, B, Zn and Cu and poorly-extractable (<20%) including Al, Fe, Mn, Ba, Ca and Sr. The results of analysis were evaluated statistically using ANOVA one-way and three-way analysis of variance, variance correlation test and Spearman's test.