In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

OBJECTIVE: During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. METHODS: Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. RESULTS: We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. CONCLUSIONS: Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.

Sex and gender differences in the neurological and neuropsychiatric symptoms of long COVID: a narrative review

COVID-19 was deemed a global pandemic in March 2020 and, since then, millions of people have been affected worldwide. Now, nearly two years later, the long-term sequelae of the virus are becoming increasingly appar-ent. This novel form of the disease, commonly referred to as “long COVID”, appears to be more common in females than in males. In this narrative review, we consulted published studies on long COVID reporting sex-disaggregated findings and discuss the possible mechanisms underlying potential sex differences. We found that females are more likely to experience milder acute COVID-19 disease, lower mortality, and a higher number of persistent physical, cognitive, neu-rological, and neuropsychiatric symptoms compared to males. Stronger innate and adaptive immune responses in females may be one of the mechanisms underlying this sex difference. The arrival of COVID-19 presents a unique occa-sion to study sex differences in the prevalence, symptomatol-ogy, risk factors, and disease progression shortly after disease emergence. We argue that advantage must be taken of this opportunity to provide researchers with the proper tools to address sex differences in COVID-19 and effectively tailor assessments and treatments toward individual needs. © 2022, Il Pensiero Scientifico Editore s.r.l.. All rights reserved.