Acute TNFα levels predict cognitive impairment 6-9 months after COVID-19 infection.

BACKGROUND: A neurocognitive phenotype of post-COVID-19 infection has recently been described that is characterized by a lack of awareness of memory impairment (i.e., anosognosia), altered functional connectivity in the brain's default mode and limbic networks, and an elevated monocyte count. However, the relationship between these cognitive and brain functional connectivity alterations in the chronic phase with the level of cytokines during the acute phase has yet to be identified. AIM: Determine whether acute cytokine type and levels is associated with anosognosia and functional patterns of brain connectivity 6-9 months after infection. METHODS: We analyzed the predictive value of the concentration of acute cytokines (IL-1RA, IL-1ß, IL-6, IL-8, IFNγ, G-CSF, GM-CSF) (cytokine panel by multiplex immunoassay) in the plasma of 39 patients (mean age 59 yrs, 38-78) in relation to their anosognosia scores for memory deficits via stepwise linear regression. Then, associations between the different cytokines and brain functional connectivity patterns were analyzed by MRI and multivariate partial least squares correlations for the whole group. RESULTS: Stepwise regression modeling allowed us to show that acute TNFα levels predicted (R2 = 0.145; ß = -0.38; p = .017) and were associated (r = -0.587; p < .001) with scores of anosognosia for memory deficits observed 6-9 months post-infection. Finally, high TNFα levels were associated with hippocampal, temporal pole, accumbens nucleus, amygdala, and cerebellum connectivity. CONCLUSION: Increased plasma TNFα levels in the acute phase of COVID-19 predict the presence of long-term anosognosia scores and changes in limbic system functional connectivity.

Acute TNFα levels predict cognitive impairment 6-9 months after COVID-19 infection

Background A neurocognitive phenotype of post-COVID-19 infection has recently been described that is characterized by a lack of awareness of memory impairment (i.e., anosognosia), altered functional connectivity in the brain's default mode and limbic networks, and an elevated monocyte count. However, the relationship between these cognitive and brain functional connectivity alterations in the chronic phase with the level of cytokines during the acute phase has yet to be identified. Aim Determine whether acute cytokine type and levels is associated with anosognosia and functional patterns of brain connectivity 6-9 months after infection Methods We analyzed the predictive value of the concentration of acute cytokines (IL-1RA, IL-1β, IL-6, IL-8, IFNγ, G-CSF, GM-CSF) (cytokine panel by multiplex immunoassay) in the plasma of 39 patients (mean 59, 38-78) in relation to their anosognosia scores for memory deficits via stepwise linear regression. Then, associations between the different cytokines and brain functional connectivity patterns were analyzed by MRI and multivariate partial least squares correlations for the whole group. Results Stepwise regression modelling allowed us to show that acute TNFα levels predicted (R2 = 0.145;β =-0.38;p =.017) and were associated (r= -0.587;p<.001) with scores of anosognosia for memory deficits observed 6 to 9 months post-infection. Finally, high TNFα levels were associated with hippocampal, temporal pole, accumbens nucleus, amygdala, and cerebellum connectivity. Conclusion Increased plasma TNFα levels in the acute phase of COVID-19 predict the presence of long-term anosognosia scores and changes in limbic system functional connectivity.

Frequency of Abnormally Low Neuropsychological Scores in Post-COVID-19 Syndrome: the Geneva COVID-COG Cohort.

OBJECTIVE: Several studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods. METHOD: Validated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data. RESULTS: The cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits. CONCLUSIONS: Moderate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection.

Telemedicine at the heart of management of the COVID-19 crisis

During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient’s trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.

P.0805 Impact of peritraumatic dissociation in hospitalized patients with COVID-19 pneumonia: a longitudinal study

Background: Psychiatric impact of COVID-19 is still explored and previous data suggest potential long-term risks of anxiety, depression and PTSD related to COVID-19 1,2,3. We aimed to explore the predictive value of risk factors during hospitalization for COVID-19 for anxiety, depression and PTSD and at three months because they could differ over these two time points. Methods: We performed a screening of mental suffering in hospitalized patients for COVID-19, as well as specialized care and three months longitudinal follow-up. We evaluated the prevalence of anxiety, depression and PTSD in survivors who benefited from early detection and treatment, during hospitalization for COVID-19 (T0) and three months after (T1) and assessed possible risk factors in adults surviving COVID-19 between the 30th March and the 1st of July 2020. Univariate and multivariate regressive linear model have been built to assess the factors associated with the post-traumatic stress disorder scale 5 (PCL5) and Hospital Anxiety and Depression Scale (HADS) at T0, and T1. For the univariate model of HADS and post-traumatic stress disorder scale 5 (PCL5) at T1, we also included HADS and PCL5 at T0. We used STATA 15 for the statistical analyses. Results: A total of 364 patients were hospitalized between the 30th of March and 1st of July 2020 and of these, 109 patients were screened at T0 and 61 of these were reassessed at T1. During hospitalization, we found 44.9% pathological score on PDEQ, 14.6% with a score of PCL5 > 31 and three months after hospitalization, 10.6% of PCL5 score >31. Finally, PDEQ score at T0 was positively correlated to PCL5 score at T1 (β=0.26, p=0.01) and that was confirmed in multivariate analysis (β=0.04, p=0.02 for the log of PCL5 per point on the PDEQ). Female gender was associated with higher HADS-Depression score during hospitalization in both univariate and multivariate regression models (β=0.58 for the log of HADS-D, p=0.019, data not shown, available upon request). Age ≥ 65 years old was associated with lower HADS-Depression at T0 (p=0.027) only in the univariate analysis. Psychiatric follow-up recorded at 1 month following hospitalization was associated with higher HADS-Anxiety score at T1 (β=0.52, p=0.028) only in the multivariate analysis. In univariate analysis, PDEQ, HADS-Anxiety, HADS-Depression and PCL5 scores during hospitalization were correlated with PCL5 score at T1. Patients requiring an ICU stay, compared to those who did not, had significantly higher PDEQ score during hospitalization (24.1 versus 15.6, p = 0.0014), but a lower HADS-A score three months after hospitalization (5.3 vs 2.3, p=0.01) and a lower HADS-D score at T0 (5.4 vs 2.6, p=0.01). In the multivariate analysis using the log of the outcomes, ICU stay was associated with a lower PCL5 at T1 (β=-1.24, p=0.012), a lower HADS-A at T1 (β=-0.77, p=0.019), and lower HADS-D at T0 (β=-1.03, p=0.004), and T1 (β-1.06, p=0.023). Conclusion: Screening of psychiatric symptoms during hospitalization for COVID-19 should be systematic, especially peritraumatic dissociation to offer an early treatment and prevent PTSD, which seemed frequent for hospitalized patients for COVID-19 at three months. No conflict of interest