Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection Part 1: Cognitive functioning.

OBJECTIVE: Long-term cognitive sequelae of COVID-19 have not been extensively studied. This study provides initial results on cognitive outcomes in Post-Acute Sequelae of COVID-19 (PASC).Participants and Methods: This study examined 53 consecutive outpatients diagnosed with COVID-19. Four participants were excluded due to performance validity test failure. All participants had positive COVID-19 tests, reported cognitive concerns, and completed neuropsychological tests to assess performance validity, attention/working memory, processing speed, memory, language, visual-spatial, executive functioning, motor, and emotional functioning. The sample was mostly white (89.8%), female (83.7%), and never hospitalized (69.4%) for COVID-19. RESULTS: Analyses indicated no mean scores in the Impaired range (>2 standard deviations [SD] below normative mean) on objective cognitive testing and a low base rate of Impaired test scores. Higher (>20%) base rates of Borderline performance (1-2 SDs below normative mean) were found on some measures. There was also evidence for frequently elevated mean scores on mood measures which correlated with some cognitive measures and the number of Borderline scores per participants. CONCLUSIONS: The results were noteworthy for infrequent Impaired scores, and significant correlations between cognition and mood/anxiety measures, but not between cognitive performance and premorbid vascular risk factors, psychiatric diagnoses, or COVID-19 disease severity. Results suggest that psychological distress was prominent in PASC and related to objective cognitive performance, but objective cognitive performance was unrelated to cognitive complaints. Other contributing factors may include fatigue/sleep issues. Neurologically based cognitive deficits were not suggested by the results.

Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection part 2: Psychological functioning.

Limited research investigating the long-term psychological and emotional correlates of COVID-19 infection has been completed. The current study begins to address this limitation in patients experiencing Post-Acute Sequelae SARS-CoV-2 (PASC; e.g. "Long COVID").Participants were 43 consecutive neuropsychological outpatients diagnosed with PASC and who completed the Personality Assessment Inventory (PAI). The sample was predominantly female (n = 36) and white (n = 32). Effect sizes compared to the normative mean T scores and base rates of elevated (T > 69) scores were calculated.PAI scales measuring somatic preoccupation and depression had large effect sizes and the highest base rates of scale elevations, with the mean T score at approximately the normative cutoff for clinical significance (T = 70). The Schizophrenia Thought Disorder subscale (SCZ-T) also had a large effect size and high base rate of elevation, likely reflecting cognitive concerns. Scales measuring anxiety had medium effect sizes. The other PAI scales generally had small to negligible effect sizes. There were no significant differences between hospitalized and non-hospitalized participants on the PAI.Overall, PAI scales measuring psychological distress, particularly somatic preoccupation and depression, were the most frequently elevated in the participants. The specific reasons for somatic preoccupation could not be determined in this study. Potential explanations include a vulnerability to distress in Long COVID patients, premorbid somatic preoccupation perhaps motivating these patients to seek clinical attention, or socioenvironmental factors leading some COVID patients to be somatically preoccupied with minor physiological changes and attribute those changes to COVID-19.

Neurocognitive deficits in severe COVID-19 infection: Case series and proposed model.

Objective: To date, very few studies investigating neurocognitive deficits in COVID-19 have been published. This case series addresses cognition in post-COVID-19 patient by describing three patients in acute rehabilitation to inform a model of cognitive sequelae of COVID-19. Methods: Three English-speaking inpatients with severe symptoms and long-term intensive care unit (ICU) treatment are described. All patients had a premorbid history of hypertension and hyperlipidemia and experienced delirium and hypoxemia when hospitalized. Patient 1 is a 62-year-old male with 15 years of education with additional history of obstructive sleep apnea and type 2 diabetes. Patient 2 is a 73-year-old female with 12 years of education with a premorbid medical history of alcohol use disorder and Guillain-Barre syndrome. Patient 3 is a 75-year-old male with 14 years of education. No patients had premorbid psychiatric histories. Results: The three patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. Memory measures improved with a more structured story memory task compared to a less-structured verbal list-learning task, suggesting executive dysfunction impacted learning. None of the patients demonstrated rapid forgetting of information. Two patients endorsed new depressive and/or anxiety symptoms. Conclusions: The results suggest evidence for neurocognitive deficits after severe COVID-19 infection, particularly in encoding and verbal fluency. These results were interpreted with caution given the limited number of patients and the telephone-based battery. The specific mechanism that caused these cognitive deficits in these individuals remains unclear. A proposed three-stage model of cognitive dysfunction is described to help guide future research.