Characteristics of Patients Seeking Treatment for "Brain Fog" Secondary to Post-Acute Sequelae of COVID-19 (PASC) in the Deep South

Objective: Describe those with persistent neuropsychiatric symptoms seeking treatment for Post-Acute Sequelae of COVID-19 (PASC). Method: Patients were referred for neuropsychological evaluation from the University of Alabama at Birmingham (UAB) Post-COVID Treatment Program. Ninety-seven patients completed a comprehensive set of self-report questionnaires. Results: Patients were 49 years old (range: 18 to 74), had 15.49 years (SD = 2.43) of education, and identified as female (77%), married (51%), and White/Caucasian (73%) or Black/AA (25%). Reported annual income ranged from ≤ $20,000 (11%) to ≥ $100,000 (32%), with 75% currently employed. Confirmed positive test result for COVID-19 was reported in 88%, with 87% having the original virus and 13% the Delta variant, based on estimated dates of infection. Symptoms during the acute illness included: headache (76%), fever (51%), cough (57%), shortness of breath (56%), and loss of smell or taste (54%). Most of the participants were not hospitalized (76%) nor required oxygen therapy (78%). Persistent symptoms included: headache (55%), shortness of breath (53%), muscle and joint pain (53%), cough (17%), congestion (40%) and loss of smell or taste (25%). Of these participants, 87% reported they had not returned to their baseline health because of COVID-19 and most indicated impaired job performance following COVID-19 infection. Conclusion: Those who sought treatment for persistent neuropsychiatric symptoms following a symptomatic course of COVID-19 were commonly middle aged, White, women, with at least a high school education. "Brain fog" secondary to PASC can result in reported persistent health and neuropsychiatric issues that can impact ability to work. [ FROM AUTHOR] Copyright of Archives of Clinical Neuropsychology is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Neurocognitive Performance in Post-Acute Sequelae of COVID-19 (PASC)

Objective: Describe cognitive function in patients seeking treatment for Post-Acute Sequelae of COVID-19 (PASC). Method: Ninety-two patients underwent neuropsychological evaluation secondary to reported “brain fog” following COVID-19 infection. Patients were referred from the University of Alabama at Birmingham (UAB) Post-COVID Treatment Program. Patients were on average 49 years of age (range: 18-74), female (77%), and White/Caucasian (73%)/Black/AA (25%), with 15.49 years of education (SD = 2.43). Results: Overall, many patients demonstrated mild impairment on a brief global cognitive screener (MoCA;M = 24.78, SD = 3.46). On specific tasks of cognitive abilities, processing speed was variable;ranging from low average (Oral TMT Part A;M = 88.31, SD = 28.78) to below average (Oral SDMT;M = 72.80, SD = 20.37). Memory for immediate recall was low average (CVLT3-Brief Form (BF) Trials 1-4, M = 88.01, SD = 17.11), while delayed recall was average (CVLT3-BF, M = 94.17, SD = 19.11). Performances on measures of attention/working memory (WAIS-IV Digit Span;M = 96.75, SD = 12.54), executive functioning (Oral TMT Part B;M = 92.71, SD = 28.48), language (COWAT;M = 92.03, SD = 14.19) and visuospatial abilities (RBANS Figure Copy M = 104.04, SD = 16.08) were intact. Performance on embedded validity measures was also intact (RDS [95% valid];CVLT-3 FC [93% valid]). Conclusion: Overall, patients with “brain fog” following COVID-19 infection experience difficulties in specific domains of cognitive functioning. Further investigation of neuropsychological profiles associated with PASC is warranted to inform diagnosis, neurocognitive trajectory, and treatment planning.

Neuropsychiatric Symptoms in Post-Acute Sequelae of COVID-19 (PASC)

Objective: To describe psychiatric symptoms in a sample of patients seeking treatment for “brain fog” due to Post-Acute Sequelae of COVID-19 (PASC). Method: Patients were referred for a neuropsychological evaluation from the University of Alabama at Birmingham (UAB) Post-COVID Treatment Program. Ninety-two patients completed a battery of self-report questionnaires to measure mood symptoms and behavior. Patients were on average 49 years of age (range: 18 to 74), female (77%), and White/Caucasian (73%)/Black/African American (25%), with 15.49 years of education (SD = 2.43). Results: On average, patients who sought treatment for PASC reported mild to moderate anxiety (Generalized Anxiety Disorder Assessment [GAD-7];M = 9.83, SD = 6.07), moderate depression (Patient Health Questionnaire [PHQ-8];M = 13.23, SD = 5.81), moderate stress levels (Perceived Stress Scale [PSS];M = 22.97, SD = 7.99). They also reported overall functional impairment in activities of daily living (Functional Assessment Questionnaire [FAQ];M = 9.57, SD = 8.29) and perceived cognitive impairment (Cognitive Failures Questionnaire [CFQ];M = 55.22, SD = 18.66). Additionally, patients endorsed several somatic symptoms (PHQ-15;M = 13.90, SD = 5.16), mild insomnia (Insomnia Severity Index [ISI];M = 14.80, SD = 6.85), and severe fatigue (Chalder’s Fatigue Scale [CFS];M = 25.53, SD = 5.72). Conclusion: Patients seeking treatment for “long-COVID” report a variety of clinically significant psychiatric symptoms, suggesting the need for incorporating behavioral, lifestyle, and psychological interventions in the treatment of this population.

Semantic Integration of Heterogeneous Data Sources Using Ontology-Based Domain Knowledge Modeling for Early Detection of COVID-19.

The enormous outbreak of biomedical knowledge, the aim of reducing computation and processing costs and the widespread availability of internet connection have created a profuse amount of electronic data. Such data are stored across the globe in various data sources that are semantically, structurally and syntactically different. This decentralized nature of biomedical data has made it difficult to obtain a unified view of the data. Data integration plays a crucial role in enhancing access to heterogeneous data making the retrieval easier and faster. A variety of ontology, machine learning, deep learning and fuzzy logic-based solutions are being developed for heterogeneous data integration. The proposed model concentrates on the automatic ontology-based data integration method that can be effectively deployed and used in the healthcare domain. The proposed model is divided into three phases. The first phase includes the automatic mapping of data and generation of local ontology across heterogeneous data sources, the second phase combines the local ontology models developed in the first phase to create a root global schema mapping and the third phase queries diverse databases to retrieve semantically analogous records. The model is created based on the medical records, chest X-ray details and COVID-19 symptom questionnaire data of various patients distributed across three data sources (SQL, mongodb and excel). Based on the data, the patients who have moderate/higher risk of developing serious illness from COVID-19 are retrieved.

Autonomic neuropathy as post-acute sequela of SARS-CoV-2 infection: a case report.

Symptoms of autonomic dysfunction, particularly those of orthostatic intolerance, continue to represent a major component of the currently recognized post-acute sequelae of SARS-CoV-2 infections. Different pathophysiologic mechanisms can be involved in the development of orthostatic intolerance including hypovolemia due to gastrointestinal dysfunction, fatigue-associated deconditioning, and hyperadrenergic state due to pandemic-related anxiety. Additionally, there has been a well-established association of a common primary autonomic disorder like postural orthostatic tachycardia syndrome, a subtype of orthostatic intolerance, with antecedent viral infections. Here we report a case of neuropathic type postural orthostatic tachycardia syndrome as a form of autonomic neuropathy that developed following COVID-19 infection.

Delayed post-hypoxic leukoencephalopathy in an adult with COVID-19.

As the novel coronavirus, SARS-CoV-2, has enveloped the world in a pandemic, it has become clear that the symptoms extend far beyond the respiratory system and have particularly caused a wide range of neurologic CNS complications, including diffuse leukoencephalopathy. Here, we describe a case of a 59-year-old male with severe COVID-19 infection who developed severe encephalopathy, which persisted well after his acute infection had subsided and had begun to improve from his respiratory dysfunction. He was found to have diffuse leukoencephalopathy with concomitant diffusion restriction on MR imaging. This case represents a delayed onset of leukoencephalopathy secondary to hypoxia in a small but growing cohort of COVID-related leukoencephalopathy due to similarities in imaging features and lack of superior alternate diagnosis. Patient's clinical improvement suggests reversibility with likely pathology being demyelination rather than infarction.

Emerging Neurology of COVID-19.

The virus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the current pandemic known as coronavirus disease 2019 (COVID-19) with severe respiratory illness as the predominant manifestation. Neurologic complications from COVID-19 were reported in the early stages of the pandemic and are now increasingly recognized. These include various symptoms like headache and anosmia as well as neurologic complications of severe COVID-19 like encephalopathy, seizures, and stroke. There are few reports of direct involvement of the central nervous system with SARS-CoV-2 causing meningoencephalitis. There is concern for higher incidence and severity of COVID-19 in patients with chronic neurologic conditions. Here, we review the emerging literature along with our anecdotal experience in regard to these neurologic manifestations in patients with COVID-19 and detail the putative pathophysiologic mechanisms for the same.