Improving Neuropsychological Rehabilitation for COVID-19 Patients Guideline-Based Advances

Cognitive sequelae after recovery from an initial COVID-19 disease are present in a subset of affected individuals, coalescing around several important issues such as effects of age, COVID-19 disease severity, comorbidities, and other factors. Some neuropsychological symptoms appear more common among certain patient populations. Comorbidities may complicate neuropsychological assessment as well. Hence, we need a guideline-based evaluation to guide neuropsychological rehabilitation. Drawing from the recent revision of the German National Guideline for the Long- and Post-COVID Syndrome and current advances in international guidance on neuropsychological assessment, this article provides practical and scientifically informed recommendations for the neuropsychological assessment of individuals recovering from coronavirus-related diseases.

Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study.

Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7; p < 0.0001) as a result of significant amelioration in the following domains: attention task (p = 0.014), abstract reasoning (p = 0.003), language repetition (p = 0.002), memory recall (p < 0.0001), orientation (p < 0.0001), and visuospatial abilities (p < 0.0001). Moreover, the improvement remained significant after multivariate analysis adjusted for several confounding factors. Finally, at discharge, 43% of the patients with cognitive impairment normalized their cognitive function, while 4.7% were discharged with residual moderate cognitive impairment. In conclusion, our study provides evidence of the effects of multidisciplinary rehabilitation enhanced with neuropsychological treatment on improvement in the cognitive function of post-acute COVID-19 patients.

Tele-Global Examination of Mental State (Tele-GEMS): an open tool for the remote neuropsychological screening.

Tele-neuropsychology, i.e., the application of remote audio-visual technologies to neuropsychological evaluation or rehabilitation, has become increasingly popular and widespread during and after the COVID-19 pandemic. New tools with updated normative data and appropriate methodological developments are necessary. We present Tele-GEMS, a telephone-based cognitive screening developed on N = 601 Italian participants. It yields a global score tapping on orientation, memory, spatial representation, language, and pragmatic abilities. Its administration lasts about 10 min. Clinical cut-offs are provided, accounting for demographic variables (age, education, and sex) and also for a comprehensive index taking into account cognitively stimulating life experiences that can build up a cognitive reserve. Tele-GEMS shows good internal consistency and a good inter-rater agreement. The test includes the thresholds for estimating a significant change after repeated measurements. Tele-GEMS has a good construct validity as assessed with MoCA and a suitable criterion validity assessed with its in-person version (GEMS). All the materials and the instructions, including scripts and an online Application for the automatic calculation of cut-offs, are accessible on OSF at https://osf.io/t3bma/ under a Creative Commons license.

To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic.

Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.

Self-perception of cognitive sequels in post-COVID-19 individuals.

COVID-19 is an infection, primarily respiratory, caused by the SARS-CoV-2, which can also affect the central nervous system, causing neuropsychological damage. There are studies describing post-COVID-19 cognitive deficits, but it is important to know this outcome in populations with different social, biological, and cultural characteristics. Objective: The aim of this study was to assess the self-perception of cognitive sequelae in post-COVID-19 individuals and identify whether there is a possible relationship between the outcome of the participants' self-perception and sociodemographic and clinical data. Methods: This is a cross-sectional study, carried out through an online questionnaire on the Google Forms platform, in which sociodemographic data, general health data, clinical manifestations of COVID-19, and post-COVID-19 self-perception of the cognitive domains of memory, attention, language, and executive functions were collected. Results: The final sample consisted of 137 participants, and it was possible to identify that memory and attention were the domains with the highest impression of worsening post-COVID-19, followed by executive functions and language. In addition, it was identified that being female may be related to a worse self-perception of all cognitive functions and that having depression or other psychiatric diseases and obesity can significantly affect at least half of the cognitive domains evaluated. Conclusions: This study pointed to a post-COVID-19 cognitive worsening of the participants.

A COVID-19 é uma infecção, primariamente respiratória, causada pelo vírus SARS-CoV-2, mas que também pode atingir o sistema nervoso central, ocasionando danos neuropsicológicos. Há estudos que descrevem os déficits cognitivos pós-COVID-19, mas é importante conhecer esse desfecho em populações com diferentes características sociais, biológicas e culturais. Objetivo: Avaliar a autopercepção de sequelas cognitivas em indivíduos pós-COVID-19 e identificar se há uma possível relação entre o desfecho da autopercepção dos participantes e dados sociodemográficos e clínicos. Métodos: Trata-se de um estudo transversal, realizado com o uso de um questionário online na plataforma Google Forms, no qual foram identificados dados sociodemográficos, dados de saúde geral, manifestações clínicas da COVID-19 e a autopercepção dos domínios cognitivos de memória, atenção, linguagem e funções executivas pós-COVID-19. Resultados: A amostra final foi composta de 137 participantes, e pôde-se observar que memória e atenção foram os domínios com maior impressão de piora pós-COVID-19, seguidos por funções executivas e linguagem. Além disso, constatou-se que ser do gênero feminino pode estar relacionado com uma pior autopercepção de todas as funções cognitivas pós-COVID-19 e que ter depressão ou outras doenças psiquiátricas e obesidade pode afetar significativamente pelo menos metade dos domínios cognitivos avaliados. Conclusões: Este trabalho apontou para a piora cognitiva pós-COVID-19 dos participantes.

Impact of anti-epidemic measures on the dynamics of the incidence of COVID-19 in medical organizations with a psychoneurological profile

Aim of the study was to evaluate the impact of anti-epidemic measures (CAM) complex on the dynamics of the epidemic process of COVID-19 in a controlled cohort of patients. Material and methods. Patients from 30 social long-term care institutions of the city were included in the study, including neuropsychiatric boarding schools, boarding houses for labor veterans, gerontological centers, and houses for stage veterans. A total of 8303 patients participated in the study, of which 4237 were men (mean age 53.6 years) and 4066 were women (mean age 62.0 years). Vaccination was carried out with Gam-Covid-Vac. Results and discussion. For the entire observation period from March 2020 to August 2021, 1619, cases of COVID-19 or 19.5% of the total number of patients were registered among patients. At the initial epidemic stage (spring-summer 2020), the incidence of COVID-19 among patients was explosive. At the same time, in the autumn-winter period of 2020, an increase in the incidence of COVID-19 was also observed. However, much less pronounced than in April 2020. Despite the progress, it was decided to strengthen the sanitary and anti-epidemic regime in institutions with the introduction of additional preventive measures. One of the most effective long-term algorithms for reducing the infectious disease incidence was vaccination. In this regard, the Moscow Department of Healthcare suggested the need for voluntary vaccination of 100% of patients in all institutions at the beginning of 2021. In the spring of 2021, the number of cases began to increase in the city. The increase in the incidence of COVID-19 was insignificant among the patients of institutions: the maximum number of cases detected in one month during this period was 13 people (in April), or 60.5 times less than in April 2020, and 2.5 times less than in October 2020. The incidence of COVID-19 has become sporadic rather than epidemic. Conclusion. The introduction of CAM in long-term care social institutions in the early stages of the epidemic contributed to a decrease in the incidence of COVID 19. 100% vaccination of patients in combination with other prevention measures reduced the incidence of COVID-19 by more than 28 times. At the same time, it was found that there is a trend of increasing incidence depending on the increase in the level of independent activity of patients.Copyright © 2023 The authors.

The CRISIS Approach When Autonomy and Beneficence Are in Conflict (CS358)

Outcomes: 1. Utilizing CRISIS approach, participants can employ a unique strategy to holistically support patients with poor coping in an acute life-threatening situation. 2. Utilizing the CRISIS approach, participants will apply an ethical tool to mitigate the incongruence that sometimes happens between two ethical principles-autonomy versus beneficence. Autonomy is not always in harmony with beneficence. We present a patient with decisional capacity hospitalized with acute reversible neuromuscular paralysis who refused treatment despite expected recovery. Her decision created moral distress for the clinicians. An improvised palliative strategy resolved the above dilemma. Case presentation: 68-year-old female admitted with new-onset unsteady gait, diplopia, and speech impairment on waking up. She was healthy until 3 weeks before admission, when she developed upper extremity numbness progressing to both legs after a COVID-19 infection. She had bulbar and axial muscle weakness and right oculomotor nerve palsy with ptosis. Positive ice pack and pyridostigmine test indicated myasthenia gravis (MG). During hospitalization, she required mechanical ventilation secondary to acute respiratory failure from progressive paralysis. Serum-negative MG diagnosed, given the response to IVIG and pyridostigmine. The patient, amid acute crisis, refused therapies and wanted to transition to DNR-comfort care despite understanding the reversibility of her illness. Her family members supported comfort care option. Neurology was conflicted with the patient's choice because MG was treatable. Palliative care, ethics, and neuropsychology consulted to establish decision-making capacity, goals-of-care, and holistic support. Intervention(s): Palliative team utilized the CRISIS approach to address the impasse between the patient and the clinicians: 1. Continue care, collaborate with the teams 2. Respond empathetically 3. Integrate patient's autonomy 4. Support holistically 5. Improvise a care plan 6. Sustain quality of life We validated patient's autonomy. We recommended allowing time for the patient/family to process her illness. We continued holistic support and symptom management and created an improvised multidisciplinary plan to help her cope with the acute illness. The above approach enabled her to opt for therapies instead of comfort care only, and she gradually recovered. Respecting patients' autonomy and incorporating beneficence via our intervention led to positive outcomes. The CRISIS approach could help other clinicians in the situation when conflict arises between autonomy and beneficence.Copyright © 2023

The Assessment of Intelligence: What is Behind Us, Before Us and Ahead of Us

Scholars struggle to define intelligence, despite over a century of research on this topic. The definition of intelligence, and consequently its utility, depends on the theoretical orientation of the clinician or researcher. In this chapter, we briefly review the origins and development of intelligence testing and current theories of intelligence. We adopt a clinical neuropsychological perspective and explore the clinical applications of intellectual assessment today, as guided by the extant literature. We challenge the notion that intelligence exists as a unified construct that can be defined by a single score, and we explore the implications and limitations through a cultural lens. Finally, we discuss the future of intellectual assessment in the COVID-era and beyond. © 2022 Elsevier Ltd. All rights reserved

Coordination and Cognition in Pure Nutritional Wernicke's Encephalopathy with Cerebellar Degeneration after COVID-19 Infection: A Unique Case Report.

BACKGROUND: Alcoholic cerebellar degeneration is a restricted form of cerebellar degeneration, clinically leading to an ataxia of stance and gait and occurring in the context of alcohol misuse in combination with malnutrition and thiamine depletion. However, a similar degeneration may also develop after non-alcoholic malnutrition, but evidence for a lasting ataxia of stance and gait and lasting abnormalities in the cerebellum is lacking in the few patients described with purely nutritional cerebellar degeneration (NCD). METHODS: We present a case of a 46-year-old woman who developed NCD and Wernicke's encephalopathy (WE) due to COVID-19 and protracted vomiting, resulting in thiamine depletion. We present her clinical course over the first 6 months after the diagnosis of NCD and WE, with thorough neuropsychological and neurological examinations, standardized clinical observations, laboratory investigations, and repeated MRIs. RESULTS: We found a persistent ataxia of stance and gait and evidence for an irreversible restricted cerebellar degeneration. However, the initial cognitive impairments resolved. CONCLUSIONS: Our study shows that NCD without involvement of alcohol neurotoxicity and with a characteristic ataxia of stance and gait exists and may be irreversible. We did not find any evidence for lasting cognitive abnormalities or a cerebellar cognitive-affective syndrome (CCAS) in this patient.

What influence do face masks have on reading emotions in faces?

In the past years, no event has affected people around the globe more than the SARS-COVID-2 pandemic. Besides the health system and the economy, it has affected social life. A grave sequela is the social distancing due to the ubiquitous use of medical face masks. Since these face masks cover approximately two thirds of the face including the mouth and nose, we hypothesized that they may impair affect reading of emotional face expressions. We used functional magnetic resonance imaging in 16 healthy volunteers to investigate brain activity changes related to the recognition of evolving emotional face expressions in short video-clips. We found that the face masks delayed emotion recognition, but at a normal nearly 100% success rate. This effect was related to a decreased activation in the cortical network mediating face recognition. Our data support the notion that face masks can have an adverse impact of social interactions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Assessing and intervening with children who have been traumatized

Nearly a billion children have had their lives disrupted by the 2019-2021 SARS CoV 2 (Severe Acute Respiratory Syndrome Coronavirus 2;COVID-19) global pandemic, with some estimates suggesting that the economic devastation may result in nearly 725 million children living in poverty in the absence of any mitigating policies (UNICEF, 2020). Given the likelihood of trauma exposure and the almost certainty of being impacted by the global pandemic, it is vital for educators, parents, and public health officials to have a better understanding of the neuropsychological factors underscoring both trauma and resilience in order to better meet the needs of our students. After all, not all children exposed to trauma and adversity experience detrimental outcomes, and many children are capable of devising internal coping and resilience strategies to grow from these experiences. This chapter discusses the various types of trauma that children typically encounter, how trauma impacts key regions in the brain responsible for learning and social-skills development, offer assessment strategies, and suggest targeted intervention strategies for schools and parents in light of some of the unprecedented circumstances our children must face. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

"Everyone is just trying to make it to the end of the shift": Neuropsychology review of staff experiences in acute stroke services at NHNN

Introduction: Effective multidisciplinary team working enhances patient care and staff performance and reduces length of stay. In stroke services, this has recently been strained by challenges of staff shortages, team exhaustion and COVID-19, in addition to SSNAP data reporting responsibilities. Consequently, psychological distress has heightened in these healthcare workers. Understanding staff experiences in stroke team environments is crucial to staff retention, wellbeing, and reshaping effective multidisciplinary processes. Method(s): Clinical staff in emergency, hyperacute, and acute stroke units at our hospital were invited in May 2022 to complete an online questionnaire based on validated measures of teamwork, stress, and burnout. Result(s): Twenty-seven respondents represented across therapy, medical (29.6%), and nursing (29.6%) teams. Teamworking was rated as positive by most staff (63%), relating this to open communication and diverse, specialised stroke knowledge. Over 75% of the sample experienced moderate to high burnout, with prevalent experiences of emotional exhaustion. External pressures to meet SSNAP requirements was a time resource barrier that lowered sense of both personal achievement and input into directing work duties. Stress was in the severe-dangerous range for 37% of respondents. Key themes identified for improvement were opportunities for education and service development, and efficiency of knowledge sharing. Conclusion(s): Our multidisciplinary stroke teams reported high levels of stress and burnout, associated with challenging staff to patient ratios, and feeling professional autonomy is compromised to meet stroke service standards. Positive experiences of teamworking were viewed as partially protective against further distress escalations. Results highlight the critical need for novel implementations focusing on team support and development.

Infectious disorders: HIV, hepatitis C, and COVID-19 pandemics

This chapter instead focuses on the neuropsychological manifestations and neuropathological underpinnings of three prominent pandemic infectious diseases: human immunodeficiency virus (HIV), hepatitis C virus (HCV), and the novel coronavirus disease of 2019 (COVID-19), given their substantial global prevalence. It shows how these pandemics highlight the complexities of characterizing neurocognition across varying dimensions of clinical disease. Through a predominantly neuropsychological lens, the chapter discusses how variations in disease duration, severity, degree of recovery, and treatment can affect brain health and related outcomes. Toward this end, it discusses how these mechanisms intersect and diverge in HIV and HCV, two historically severe infectious diseases that now have undergone significant advances in treatment. In turn, the chapter draws upon insights gained from researching the neuropsychological complications of these diseases in order to inform the assessment and diagnosis of neurocognitive impairment in the context of COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Wear a mask and don't drink bleach: The role of neurocognition and health literacy in COVID-19 information seeking skills, knowledge, prevention intentions, and prevention behaviors

The rapid development of COVID-19 into a pandemic required people to quickly acquire, evaluate, and apply complex health-related information. The present study examined the possible interplay between neurocognition and health literacy in the early uptake and use of COVID-19 public information. The current study aims were to evaluate: 1) the contribution of neurocognition to COVID-19-related online information seeking skills, knowledge, prevention intentions, and prevention behaviors;and 2) the effects of health literacy on the relationship between neurocognition and these COVID-19 outcomes. Two hundred and seventeen adults completed a telephone-based assessment including standardized measures of neurocognition, health literacy, and COVID-19 health outcomes (i.e., COVID-19 online information seeking skills, knowledge, prevention intentions, and prevention behaviors). Multiple regression models with data-driven covariates revealed that neurocognition, specifically memory and executive functions domains, was independently associated with COVID-19 knowledge, but not COVID-19 online information seeking skills, prevention intentions, or prevention behaviors. A series of hierarchical multiple regressions with data-driven covariates showed that health literacy was independently associated with all measured COVID-19-related outcomes and did not interact with neurocognition for any of these outcomes. These findings suggest that the acquisition of COVID-19 knowledge in the early months of the pandemic was partially explained by individual differences in declarative verbal memory and executive functions. Thus, future studies might examine whether executive functions and memory supports (e.g., spaced retrieval practice) can improve COVID-19-related knowledge in vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study.

OBJECTIVE: This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. RESULTS: When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st-2nd) (p=0.045). After COVID-19 (2nd-3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. CONCLUSION: Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

National survey of telehealth neuropsychology practices: current attitudes, practices, and relevance of tele-neuropsychology three years after the onset of Covid-19.

Objective: Examination of current tele-neuropsychology (teleNP) practices and attitudes within the clinical neuropsychology community, conducted September - November 2022. Method: Clinical neuropsychologists in U.S. and U.S. territories were invited to participate in an online survey of teleNP practices. The final sample consisted of 326 neuropsychologists. Results: Forty-six percent of the sample indicated they currently practice teleNP. Fourteen percent of the sample not currently practicing teleNP were considering practicing teleNP. The remainder was not practicing teleNP and had no plans to (41%). Most respondents agreed that teleNP where the patient is located in clinic is generally feasible and acceptable (71%); to a lesser extent, teleNP to home was viewed as feasible and acceptable (45% agreed, while 16% rated feasibility and acceptability as neutral). Only 11% agreed that teleNP is a feasible and acceptable part of forensic neuropsychology practice. Most respondents (74%) currently engaged in teleNP either agreed or strongly agreed that teleNP enabled them to provide similar quality of care as face-to-face neuropsychology. Current practice of teleNP was positively correlated with career phase, with greater adoption among early career neuropsychologists. Current teleNP providers anticipated teleNP to permanently comprise 31-40% of their overall practice on average. Conclusions: There is variability in teleNP acceptance by setting and career phase. While hesitancy around teleNP was expressed by some, results show that the adoption of teleNP has increased over time and remains a permanent feature of practice for a substantial number of respondents three years following onset of the Covid-19 pandemic.

Cognition in COVID-19 infected patients undergoing invasive ventilation: results from a multicenter retrospective study.

A growing number of scientific contributions suggest that COVID-19 infection can lead to impairment of cognition, mainly in executive functions and memory domains, even in the absence of frank neurological pathologies.The primary objective of this retrospective study is to evaluate the frequency and type of inefficiencies in a selection of cognitive tests administered to a sample of subjects who, following infection, required invasive assisted ventilation and were admitted to rehabilitation wards for the treatment of functional impairment.Fifty-seven subjects were enrolled. The recruited patients undergone an assessment of verbal and visuospatial memory and executive functions, upon entry into the rehabilitation department, after discharge from intensive care. The following tests were administered: Rey Auditory Verbal Learning Test (AVLT) (immediate and delayed recall), Rey-Osterrieth Complex Figure Test (ROCFT) (copy and delayed recall), Stroop Color-Word Test, and Trail Making Test (TMT, A and B).Deficient scores, in beyond 25% of subjects, were found in the copy of the ROCFT (32.1% of subjects), and in the delayed recall of ROCFT (27.2%). Between 10 and 20% of patients presented an abnormal result in delayed recall of AVLT (16.07%), and Stroop Test (time, 15.6%, error, 11.5%). Less than 10% of the sample had abnormal performances on TMT (A, 3.5%, and B, 9.4%), and in AVLT immediate recall (8.9%). Correlations of the performances with age, sex, and education were also found.This paper highlights the high incidence of abnormal cognitive performances in this specific subpopulation of patients with COVID-19 infection.

Impact of COVID-19 infection on cognition and its association with neurological symptoms.

OBJECTIVE: To characterize the cognitive profile following COVID-19 infection and its possible association to clinical symptoms, emotional disturbance, biomarkers, and disease severity. METHODS: This was a single-center cross-sectional cohort study. Subjects between 20- and 60-year old with confirmed COVID-19 infection were included. Evaluation was performed between April 2020 and July 2021. Patients with previous cognitive impairment and other neurological or severe psychiatric disorders were excluded. Demographic and laboratory data were extracted from the medical records. RESULTS: Altogether 200 patients were included, 85 subjects were female (42.3%), and mean age was 49.12 years (SD: 7.84). Patients were classified into four groups: nonhospitalized (NH, n = 21), hospitalized without intensive care unit (ICU) nor oxygen therapy (HOSP, n = 42), hospitalized without ICU but with oxygen therapy (OXY, n = 107), and ICU (ICU, n = 31) patients. NH group was younger (p = .026). No significant differences were found in any test performed attending severity of illness (p > .05). A total of 55 patients reported subjective cognitive complaints (SCC). Subjects with neurological symptoms (NS) performed worse in trail making test B (p = .013), digits backwards (p = .006), letter&numbers (p = .002), symbol digit modalities test (p = .016), and Stroop color (p = .010) tests. CONCLUSIONS: OXY patients and females referred more SCC associated with symptoms of anxiety and depression. Objective cognitive performance was unrelated to SCC. No cognitive impairment was found regarding the severity of COVID-19 infection. Results suggest that NS such as headache, anosmia, and dysgeusia during infection were a risk factor for later cognitive deficits. Tests assessing attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients.

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.