ABSTRACT
Background: Insomnia, mood decline, anxiety, and cognitive impairment are described following COVID-19, and the mechanisms underlying these symptoms are not fully clarified. Aims of this analysis were to describe prevalence and predictors of impaired neuropsychological performance after COVID-19. Methods: We included patients referred to the post-COVID19 service with and without a previous hospitalization (PH and nPH, respectively) assessed at 3,6 and 12 months (3M,6M,12M) post-COVID19. Patients underwent to a comprehensive neuropsychological assessment using a standardized battery of 10 tests across 4 domains (speed of information processing, /executive, attention/working memory, memory). Neurocognitive impairment (NCI) was defined by: score >1 standard deviation (SD) below the mean on at least 2 tests, or >2 SD below 1 test. Change in NPZ-10 (mean, SD) was analyzed as an outcome. In addition, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. Mann-Whitney and Chi-square tests were used for comparisons, and logistic and linear regression were used to identify factors associated with test results. Results: N=302 participants: median age of 55 years (IQR 47-61), 52% female, median education of 13 yrs (13-18), 63% with >1 comorbidity, 58% PH (mainly males, higher age and higher BMI vs nPH). Overall, the prevalence of NCI was 42%, higher in PH vs nPH (46% vs 36%;p=0.07) (Figure 1a) with a not statistically significant mean decrease of NPZ10 [-0.12 (0.49)]. More in detail, we observed a significant decrease of z-score in the speed of information processing domain in PH vs nPH [-0.29(0.48) vs-0.12(0.31);p<0.001]. NCI prevalence resulted significantly higher in PH vs nPH only at 3M (Figure 1b). A higher proportion of nPH vs PH complained anxiety (BAI>85%) at 3M [55.6% vs 31.4%);p=0.028], sleep disturbances were more frequent in PH vs nPH at 3 and 12M (Figure 1d,c). Male gender appear to be the only associated factor with a lower alteration of BAI>85% and PSQI>5 [OR 0.28 (0.12-0.65);p=0.003;0.22 (0.09-0.52);p=0.001;respectively]. No predictors of NCI or BDI>85% were found. Conclusion: Our preliminary data show a consistent prevalence of NCI, significantly higher in PH vs nPH. This finding remains quite stable up to 12 months of observation. Also a worse sleep quality in PH was observed. Women seem to be at higher risk of anxiety-depressive and sleep disorders than men.
ABSTRACT
Background: After the acute phase of infection, new, recurring or ongoing symptoms related to COVID19 may persist for weeks or months. Aims of our study were to size the impact of these symptoms on physical (PH) and mental (MH) health status and quality of life (QoL), reported by patients (pts), and to investigate factors influencing the perception of PH, MH, and QoL. Methods: We included pts referred to the post-COVID19 outpatient service, with and without prior hospitalization (PHosp), evaluated at 3,6 and 12 months after the acute infection. Demographic, clinical and pharmacological data were collected in an electronic system. At each visit, the Short-Form 36-item questionnaire (SF-36), assessing the perception of PH and MH, and the Visual Analogue Scale (VAS), ranging from 0 to 100, of the EQ5D, assessing QoL, were administered. Student's T-test was employed for comparisons and linear regression was used to identify factors associated with PH, MH, and QoL. In a subgroup of patients, we assessed the presence of anxiety and depressive symptoms and sleep disturbances through the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI II) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires, respectively. Results: Out of a total of 914 assessments, we considered the first one of each pt (n=572): median (IQR) age of 55 years (47-62), 53% male, 38% with at least 1 comorbidity, 54% with PHosp, median distance from acute infection of 4.8 months (3.6-7.1). The mean of each subscale assessed in SF-36 was significantly lower than the normative values of the Italian population (Figure 1) and it remained stable over time. Female gender, the presence of comorbidities, and the use of corticosteroids during the acute infection were associated with a worse perception of PH, MH, and QoL;pts with PHosp reported a better MH overall (Figure 2). Alterations in BAI, BDI II, and PSQI were associated with worse perceptions of PH, MH, and HRQoL, in the subgroup of 265 patients in whom they were evaluated. Conclusion: In our study, post-COVID19 pts reported a significantly worse perception of PH and MH status compared to the Italian normative group, and a higher risk was demonstrated for female pts, pts with comorbidities and pts treated with corticosteroids. Moreover, the presence of anxious-depressive symptoms and poor sleep quality was correlated to a worse perception of health status and QoL. A systematic monitoring of these aspects is mandatory to properly manage pts in the post-COVID19 period.