The Relationship between Handgrip Strength, Timed Up-and-Go, and Mild Cognitive Impairment in Older People during COVID-19 Pandemic Restrictions.

The COVID-19 lockdown restrictions affected physical performance and cognitive function in older people as they were confined to their homes. There is an association between physical and cognitive functions. Mild Cognitive Impairment (MCI) is a condition that risks progressing to dementia. This study aimed to identify the relationship between handgrip strength (HGS), Timed Up-and-Go (TUG), and MCI in older people during the COVID-19 pandemic restrictions. The cross-sectional study recruited 464 eligible participants for an interview and anthropometric measurement. The Montreal Cognitive Assessment-Basic (MoCA-B), HGS, and TUG were measured in addition to demographic and health characteristics. A total of 398 participants (85.8%) were found to have MCI when screened with the MoCA-B. Their mean age was 71.09 ± 5.81 years. Forward multiple regression analysis demonstrated that HGS (ß = 0.032, p < 0.001), education level (ß = 2.801, p < 0.001), TUG (ß = -0.022, p = 0.013), Thai Geriatric Depression Score, TGDS (ß = -0.248, p = 0.011), and age (ß = -1.677, p = 0.019) were associated with MCI. A decrease in HGS and an increased TUG might allow for the early detection of MCI and promote physical training in order to reduce the risk of MCI. Further studies can investigate multidomain indicators for MCI, for example, fine motor skills and pinch strength as components of the motor abilities.

METABOLIC SUPPORT FOR PATIENTS WITH MILD COGNITIVE (DODECAMENTAL) IMPAIRMENT IN THE OUTCOME OF COVID-19.

An open comparative study was conducted to assess the efficacy and safety of cytoflavin in the treatment of 50 patients who underwent SARS-CoV-2 infection, with subsequently developed mild cognitive impairment after leaving an infectious disease hospital. The survey was carried out using the Montreal Cognitive Assessment Scale (MoCA test) for the study of cognitive status, as well as the SF-36 questionnaire to determine parameters of the quality of life of patients and to assess the level of asthenia, anxiety and depression during follow-up (at the beginning of study and after 10 days of fluid therapy). Patients of the main group received intravenous infusion of cytoflavin for 10 days at a dose of 10 mL per 100 mL of 0.9% sodium chloride solution, while the comparison group received "active placebo" (100.0 mL of 0.9 sodium chloride solution) also for 10 days. During observation, the main test group patients showed significant discrepancies in the amount of complaints such as dizziness, headache, and decreased cognitive performance versus placebo group. According to the MoCA test results, patients of the main group showed higher total score on the background of improved cognitive functions: attention improved by 13.2%, p < 0.05 (subtest "repetition" of the number series in forward and reverse order and the "cotton" subtest with letter "A");regulatory skills improved by 9.8%, p < 0.05 (speaking "fluency" subtest);visual-constructive skills improved by 11.4%, p < 0.05 ("clock drawing" subtest);phrase repetition improved by 11.3%, p < 0.05, and literature associations improved by 11.3%, p < 0,05. Based on the results of the SF-36 questionnaire, the life quality was also significantly improved, by 19.5%, p < 0.05 on the average (including physical functioning and condition, pain intensity, general condition, vitality and mental health indicators). The tolerance of cytoflavin in all patients was good and there were no side effects related to the drug. Thus, the use of cytoflavin in the complex treatment of SARS-CoV-2 patients, who suffered from the infection with encephalopathy/mild cognitive impairment developed as part of the postvoid syndrome, reduces neurological deficit and helps to restore neurocognitive functions.Copyright © 2021 Eieeaeoea aaoiia

MoCA-T as a remote assessment tool to determine cognitive impairment in patients with moderate to severe OSA

The COVID-19 pandemic has led to the emergence of technological tools that allow remote assessment on patients. The Montreal Cognitive Assessment Test Telephone Version (MoCA-T) is one of them. Considered as a telemedicine resource that allows remote cognitive screening in pandemic era and in the population with difficulties in accessing health centers. Mild cognitive impairment (MCI) is a common finding in patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). However, the application of telephone tests for cognitive screening has not been studied. To determine the frequency of cognitive deterioration through the application of MoCA-T as a remote screening test in patients with moderate and severe OSAHS is the main objective of this work. To do this, the MoCA-T test was applied to 104 patients with polysomnographic diagnostic capabilities for moderate and severe OSAHS between ages 18 and 65, excluding patients with comorbidities that affect cognitive ones. Abnormal MoCA-T results were obtained in 43% of patients, with the cognitive domains of memory and attention being the most affected. Finally, abnormal MoCA-T results correlated with self-perception of memory difficulties, being more frequently altered in those who manifest cognitive complaints. The MoCA-T test could be a brief, validated and feasible technological tool for cognitive screening of patients with OSAHS in times of pandemic and in patients with care barriers.Copyright © 2023 Sociedad Neurologica Argentina

Feasibility of automated longitudinal cognitive and mood assessment in the stroke pathway

Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.

Cognitive alterations in COVID-19 survivors with and without invasive mechanical ventilation during hospital stay

Introduction: Cognitive impairment is observed in patients for Covid-19;derived from both multiple organic dysfunctions due to the disease and its management during hospital stay. Existing literature reports greater cognitive impairment (60-80%) in patients with invasive mechanical ventilation (IMV), compared to those who did not require it (50-70%). Objective(s): To compare cognitive impairment among COVID-19 survivors with and without IMV during hospital stay. Method(s): A cross-sectional observational study was conducted. A total of 211 COVID-19 survivors participated, 64.9% required IMV (G1) and 35.1% did not (G2). The Montreal Cognitive Assessment (MOCA) was used to assess cognitive functions at a 9 month follow-up after hospital discharge. Statistical analyses were performed in SPSS V25. Result(s): Patients presented the following characteristics: male sex (G1: 61.8%, G2: 54.1%), and average age G1: 54.05+/-11.89, G2: 57.21+/-11.90 years. In both groups (G1 vs. G2) no significant differences (p<0.05) were found in the prevalence of probable mild cognitive impairment (72.3% vs. 82.4%), neither in the mean of principal affections reports: attention (4. 70+/-1.23 vs. 4.80+/-1.03) and memory (2.69+/-1.53 vs. 2.86+/-1.59). Orientation (5.60+/-.71 vs. 5.82+/-.41), was the only value that reached statistically significant differences (p=.013), but without clinical significance. Conclusion(s): Both groups have high prevalence of patients with probable mild cognitive impairment yet nine months after discharge, contrasting with the prevalence reported to patients with IMV and to the recovery time (3-6 months). Cognitive sequelae have a greater impact than reported in all patients regardless of treatment.

Clinical and functional characteristics of patients recovering from severe COVID-19 attending an inpatient pulmonary rehabilitation program

Background and Aims: A proportion of patients with coronavirus disease 2019 (COVID-19) need hospitalization due to severe respiratory symptoms. This study describes the characteristics of survivors of severe COVID-19 subsequently admitted to inpatient pulmonary rehabilitation (PR) and identifies their rehabilitation needs. Subjects and methods: From the COVID-19 Registry of the Fondazione Don Gnocchi we extracted 203 patients admitted for inpatient PR after severe COVID-19 from April 2020 till September 2021. Specific information on the acute-hospital stay, clinical and functional characteristics on admission to the rehabilitation units were collected. Result(s): During the acute phase of the disease 80% of patients needed ICU admission, receiving mechanical ventilation (MV) for 26 days. On admission to the rehabilitation units, 10% of patients were still on MV, 28% had tracheostomy, 70% were on O2 therapy, 24% were diagnosed critical illness neuropathy. Eighty % showed a modified Barthel Index <75 and only 25% were able to perform a six-minute walk test. Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale were also performed, indicating a variable presence of neurocognitive impairment and symptoms of anxiety and/or depression. Moreover, 32% scored >=2 at the Malnutrition Universal Screening Tool and 47% showed dysphagia needing logopedic treatment Conclusion(s): Our analysis shows that patients admitted for inpatient PR after severe COVID-19 represent a multifaceted and clinically complex patient population who need customized, comprehensive rehabilitation programs, carried out by teams with different professional skills.

Cognitive impairment as a sequel to SARS-CoV-2 infection

Introduction: COVID-19 survivor patients report a complaint subjectively related to memory and attentionconcentration problems when carry out their daily activities. Objective(s): To investigate the presence of cognitive sequelae associated with COVID-19. Method(s): An observational cross-sectional study was conducted. Participated 229 COVID-19 survivor patients, who were evaluated with Montreal Cognitive Assessment (MoCA) and classified into three groups: a) severe cognitive impairment (G1, <13points, n=11), b) mild cognitive impairment (G2, 13-21 points, n=34), and c) without cognitive alterations (G3, 22-30 points, n=184). Statistical analyses were performed in SPSS V25. Result(s): Average age and male sex: G1: 67.36+/-10.71, 63.6%;G2: 58.76+/-11.55, 61.8%;G3: 53.32+/-11.39, 58.7%. G1 presented statistically differences (p <0.001) in all cognitive functions with the other groups (G1, G2, G3): visuospatial/executive ability (0.09+/-0.30, 0.53+/-0.50, 0.83+/-0.38), identification (2.00+/-0.89, 2.82+/-0.38, 2.92+/-0.32), attention (2.45+/-0.82, 3.97+/-1.16, 5.02+/-0.97), repetition (0.18+/-0.40, 0.29+/-0.46, 1.02+/-0.79), fluency (0.18+/-0.40, 0.68+/-0.47, 0.93+/-0.24), abstraction (0.18+/-0.40, 0.68+/-0.72, 1.41+/-0.77), deferred remembering (0.73+/-1.10, 1.44+/-1.37, 3.13+/-1.36) and orientation (4.64+/-0.92, 5.35+/-0.73, 5.79+/-0.49);except in executive ability, identification, repetition, abstraction and deferred remembering with respect to G2 (p<0.05). Conclusion(s): Cognitive alterations were found in patients post- COVID, especially in attention and deferred remembering, which could be related to errors of execution in other areas. In the case of the severe cognitive impairment, age may be a related variable. Necessary integrate this variable in the rehabilitation plan for a better prognosis and quality of life of patients.

Reliability of the NACC Telephone-administered Neuropsychological Battery (T-cog) and Montreal Cognitive Assessment for participants in the USC ADRC.

Introduction: Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). Methods: 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Results: Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P < 0.0001). Discussion: Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Highlights: Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P < 0.0001).

Tracking cognition with the T-MoCA in a racially/ethnically diverse older adult cohort.

Introduction: We investigated the utility of the Telephone-Montreal Cognitive Assessment (T-MoCA) to track cognition in a diverse sample from the Einstein Aging Study. Methods: Telephone and in-person MoCA data, collected annually, were used to evaluate longitudinal cognitive performance. Joint models of T-MoCA and in-person MoCA compared changes, variance, and test-retest reliability measured by intraclass correlation coefficient by racial/ethnic group. Results: There were no significant differences in baseline performance or longitudinal changes across three study waves for both MoCA formats. T-MoCA performance improved over waves 1-3 but declined afterward. Test-retest reliability was lower for the T-MoCA than for the in-person MoCA. In comparison with non-Hispanic Whites, non-Hispanic Blacks and Hispanics performed worse at baseline on both MoCA formats and showed lower correlations between T-MoCA and in-person versions. Conclusions: The T-MoCA provides valuable information on cognitive change, despite racial/ethnic disparities and practice effects. We discuss implications for health disparity populations. Highlights: We assessed the comparability of Telephone-Montreal Cognitive Assessment (T-MoCA) and in-person MoCA for tracking cognition.Changes within 3 years in T-MoCA were similar to that for the in-person MoCA.T-MoCA is subject to practice effects and shows difference in performance by race/ethnicity.Test-retest reliability of T-MoCA is lower than that for in-person MoCA.

Covid-19 Analysis: Is there an Association Between Covid-19 and Development of Cognitive Deficits?

Objective: The effects of COVID-19 infection were initially thought to be limited to the respiratory system; however, recent literature suggests that the virus has systemic effects, even leading to cognitive deficits. The objective of this study is to review COVID-19 related literature to determine whether there is an association between COVID-19 infection and the development of cognitive deficits. Method: A search for articles relevant to COVID-19, cognitive deficits, the Montreal Cognitive Assessment Tool (MoCA), and the geriatric population was performed on the MEDLINE, CINAHL, and APA PsychInfo databases. Results: Substantial evidence exists that reports an association between COVID-19 infection and cognitive decline. The studies included in this literature review surveyed distinct populations and reported cognitive deficits in COVID-19 patients as measured by a reduction in MoCA scores. While cognitive deficits were identified as partially reversible, there were still measurable deficits in cognition post-recovery compared to healthy controls. Furthermore, the measured cognitive deficits were found to be much worse in the geriatric population. Conclusions: Current literature shows an association between COVID-19 infection and the development of cognitive deficits. Further research should seek to characterize these cognitive deficits and determine the underlying aetiology and pathogenesis. Initiatives to develop interventions to limit or improve cognitive deficits in post COVID-19 patients is crucial, especially the elderly, given the large burden of disease within this population cohort.

Etiology-Specific Olfactory Phenotypes for COVID-19 and Mild Cognitive Impairment

Introduction: Olfactory dysfunction is a common symptom associated with COVID-19 infection. While often transient, nearly 1 in 8 patients experience persistent dysfunction after initial infection resolution. Given the known association between impaired olfaction and mild cognitive impairment (MCI), this persistent COVID-19 olfactory dysfunction may impede early detection of cognitive decline. Method(s): Patients with confirmed COVID-19-associated hyposmia (n=73), MCI (n=58), and normal controls (n=86) were prospectively enrolled. Demographic data were collected alongside formal olfactory testing via AROMA (Affordable Rapid Olfaction Measurement Assay) at time of initial enrollment. MCI was assessed via MoCA (Montreal Cognitive Assessment). Multivariate logistic regressions were utilized to evaluate for associations between variables and etiology of olfactory dysfunction. Result(s): After controlling for age and gender, when compared against normal controls, the inability to smell licorice, cinnamon, and lemon at the lowest 3 concentrations increased odds of COVID-19 hyposmia by 10.8 (95% CI, 4.6-25.6), 5.7 (95% CI, 2.7-11.7), and 5.3 (95% CI, 2.6-10.8), respectively. While the inability to smell coffee (9.9 odds ratio [OR];95% CI, 2.02-48.1), eucalyptus (6.7 OR;95% CI, 2.2-20.0), and rose (4.0 OR;95% CI, 1.7-9.7) were associated with MCI, decreased ability to smell licorice, cinnamon, and lemon were not. When combined into a composite score and compared against controls, decreased detection of licorice, cinnamon, and lemon was associated with a 16.5 OR (95% CI, 6.6-41.3) for COVID-19 hyposmia. This composite score was not significantly associated with MCI (1.2 OR;95% CI, 0.6-2.2) and, as such, performed well at discriminating between COVID-19 and MCI patients (receiver operating characteristic area under the curve=0.76). Conclusion(s): Distinct patterns of impaired olfaction were noted for COVID-19. We show that this etiology-specific phenotype has good discriminative performance when differentiating from MCI-associated hyposmia, which may allow for continued utilization of olfactory screening for MCI even among those with previous COVID-19 infection.

Mental, physical, and cognitive impairments of COVID-19 patients admitted to intensive care during the pandemic in Chile: An observational, multicentre study

Introduction: Mental, physical, and cognitive impairments are common after an intensive care unit (ICU) stay. It remains unknown to what extent the extraordinary increase in bed occupancy during the pandemic could be linked to the severity and frequency of patient's impairments. Objective: To determine the frequency, severity, and risk factors for mental, physical, and cognitive impairments at ICU discharge during high and low bed occupancy periods. Methods: Prospective cohort study in seven Chilean ICUs (ClinicalTrials.gov Identifier: NCT04979897). We included adults, mechanically ventilated >48 hours in the ICU who could walk independently prior to admission. Trained physiotherapists assessed the Medical Research Council Sum-Score (MRC-SS), Montreal Cognitive Assessment (MOCA-blind), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) at ICU discharge. Pre-admission employment status, educational level, and Clinical Frailty Scale (CFS) were also collected. We compared periods of low and high bed-occupancy, defined as less or more than 90% of staffed ICU beds occupied. We used t-test for normally distributed, Mann-Whitney for those not normally distributed, and chi-square for categorical variables. We explored risk factors for mental, physical, and cognitive impairments using logistic regression adjusted for age, sex, educational level, and bed occupancy. Analyses were performed in Stata/SE 16.0. Results: We included 192 patients with COVID-19 of which 126 [66%] were admitted during a high bedoccupancy period (January to April 2021). Majority were male (137 [71%]) and worked full-time (127 [66%]). Median [P25-P75] age was 57 [47-67], length of ICU stay was 15[ 11-27] days, and duration of mechanical ventilation (MV) was 9 [6-16.5] days. Seven (4%) patients were clinically frail, 65 (34%) had ICUacquired weakness (ICU-AW), 134(70%) had cognitive impairment, 122 (64%) had post-traumatic stress symptoms (PTSS), 53 (28%) had depressive symptoms, 106 (55%) had anxiety symptoms, and 148 (77%) had severe disability. Table 1 shows the combined prevalence of physical and mental health problems. Patients admitted during the high-occupancy period were younger (mean 54, 95% confidence interval [47, 61] vs 61 [58, 64]), more likely to have a higher education qualification(HEQ) (OR 1.67 [0.9, 3.06]), and had a shorter duration of MV (8 [6-13] vs 13 [8-34];p<0.001) and ICU stay (13 [10-19] vs 21.5 [13-42];p<0.001). Mental, physical, and cognitive impairments were similar in low and high occupancy periods. Patients with a HEQ were less likely to have ICU-AW (OR 0.23 [0.11, 0.46]), cognitive impairments (OR 0.26 [0.11, 0.6]), symptoms of depression (OR 0.45 [0.22, 0.9]) or anxiety (OR 0.26 [0.13, 0.5]), and severe disability (OR 0.4 [0.18, 0.94]). Females were more likely to have ICU-AW (OR 2.4 [1.13, 4.93]). Older patients were less likely to suffer PTSS (OR 0.97 [0.94, 0.99] per year old). Conclusions: Majority of patients had at least one mental, physical or cognitive impairment being similar by bed occupancy. Having a higher education qualification was the main protective factor for impairments at ICU discharge. Preventative treatments programmes should target patients with <12 years of education.

Fatigue and cognitive impairment after COVID-19: A prospective multicentre study.

Background: Reliable estimates of frequency, severity and associated factors of both fatigue and cognitive impairment after COVID-19 are needed. Also, it is not clear whether the two are distinct sequelae of COVID-19 or part of the same syndrome." Methods: In this prospective multicentre study, frequency of post-COVID fatigue and cognitive impairment were assessed in n = 969 patients (535 [55%] female) ≥6 months after SARS-CoV-2 infection with the FACIT-Fatigue scale (cut-off ≤30) and Montreal Cognitive Assessment (≤25 mild, ≤17 moderate impairment) between November 15, 2020 and September 29, 2021 at University Medical Center Schleswig-Holstein, Campus Kiel and University Hospital Würzburg in Germany. 969 matched non-COVID controls were drawn from a pre-pandemic, randomised, Germany-wide population survey which also included the FACIT-Fatigue scale. Associated sociodemographic, comorbid, clinical, psychosocial factors and laboratory markers were identified with univariate and multivariable linear regression models. Findings: On average 9 months after infection, 19% of patients had clinically relevant fatigue, compared to 8% of matched non-COVID controls (p < 0.001). Factors associated with fatigue were female gender, younger age, history of depression and the number of acute COVID symptoms. Among acute COVID symptoms, altered consciousness, dizziness and myalgia were most strongly associated with long-term fatigue. Moreover, 26% of patients had mild and 1% had moderate cognitive impairment. Factors associated with cognitive impairment were older age, male gender, shorter education and a history of neuropsychiatric disease. There was no significant correlation between fatigue and cognitive impairment and only 5% of patients suffered from both conditions. Interpretation: Fatigue and cognitive impairment are two common, but distinct sequelae of COVID-19 with potentially separate pathophysiological pathways. Funding: German Federal Ministry of Education and Research (BMBF).

INVESTIGATION of the EFFECT of the HISTORY of COVID-19 on COGNITIVE LEVEL, PAIN CATASTROPHIZATION, and PHYSICAL ACTIVITY LEVEL in INDIVIDUALS with CHRONIC LOW BACK and NECK PAIN

Background: Low back and neck pain is one of the most common health problems in society and one of the top reasons for admission to the hospital (1). Studies show that the level of physical activity decreases in individuals with chronic pain, and the cognitive level and quality of life are negatively affected (2). There are studies examining the effects of the Covid-19 pandemic process on the level of physical activity and cognitive level in various groups. However, the number of studies on how the history of Covid-19 affects individuals with low back and neck pain is limited. Objectives: The aim of this study is to examine the effect of Covid-19 history on cognitive level, pain catastrophe and physical activity level in individuals with chronic low back and neck pain in individuals. Methods: A total of 25 individuals with chronic pain, including 16 with low back pain and 9 with neck pain, were included in the study. Demographic data such as age, gender and body mass index (BMI) were obtained from all individuals. The education levels of the individuals were recorded. Cognitive level was assessed by the Montreal Cognitive Assessment (MoCA)[3], pain severity was assessed by the Visual Analog Scale (VAS), pain catastrophization was assessed by the Pain Catastrophizing Scale (PCS)[4], and physical activity level was assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF)[5]. Results: Table 1. Demographic data, VAS, MoCA, PCS, and IPAQ-SF scores are given in Table 1. 7 of the participants had history of Covid-19, 18 did not. The MoCA scores and education levels of individuals with Covid-19 were higher than individuals without history of Covid-19 (p<0.05). There was no difference in physical activity, pain and pain catastrophization levels between the 2 groups (p> 0.05). Conclusion: Surprisingly, individuals who had a history of Covid-19 had higher cognitive levels than individuals without a history of Covid-19. In addition, there was no difference between physical activity and pain catastrophization levels. This may be due to the higher education level of individuals with a history of Covid-19. There is a need for further studies in which education levels are similar, and hospitalization and the Covid-19 positivity process are examined in more detail.

Correlation Between Cognitive Deficits, Quality of Life and Coping Strategies in Post Covid-19 Survivors

Background: Coronavirus disease 2019 (COVID-19) has imposed a significant impact on populations and healthcare systems. Symptoms of post-COVID syndrome (PCS) persist for at least 12 months following COVID-19 infection leading to significant negative effects on these patients’ cognition, ability to work, physical activity, social interaction, and overall quality of life. Objective: This study aimed to investigate the relation between cognitive deficits, quality of life (QOL) and coping strategies in post COVID-19 survivors. Subjects and Methods: A hundred COVID-19 survivors from both genders participated in this study. Their cognition was evaluated using Montreal Cognitive Assessment (MoCA), the WHO Quality of Life Instrument-Short Form (WHOQOL-BREF) was employed to evaluate patients’ QOL and the Brief Coping Orientation to Problems Experienced (Brief-COPE) was used to assess their coping strategies. Results: A significant positive correlation was found between the scores of MoCA and all HRQOL domains (Physical health, Psychological, Social relationships, Environment, General health and General QOL). Also, a significant negative correlation was noted between scores of MoCA and Brief-COPE (Mal-Adaptive strategies) while no significant correlation was found between MoCA scores and Brief-COPE (Adaptive strategies). Conclusion: There is a relation between cognition deficits, QOL and non-adaptive coping strategies in post COVID-19 survivors, while, there is no relation between cognitive deficits and adaptive coping strategies in PCS patients.

Prevalence and severity of cognitive dysfunction in patients referred for transcatheter aortic valve implantation (TAVI): clinical and cognitive impact at 1 year.

AIM: We estimated the proportion and severity of cognitive disorders in an unselected population of patients referred for transcatheter aortic valve implantation (TAVI). Second, we describe clinical and cognitive outcomes at 1 year. METHODS: Eligible patients were aged ≥ 70 years, with symptomatic aortic stenosis and an indication for TAVI. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction (CD), defined as no CD if score ≥ 26, mild CD if 18-25; moderate CD if 10-18, and severe CD if < 10. We assessed survival and in-hospital complications at 6 months and 1 year. RESULTS: Between June 2019 and October 2020, 105 patients were included; 21 (20%) did not undergo TAVI, and thus, 84 were analyzed; median age 85 years, 53.6% females, median EuroScore 11.5%. Median MoCA score was 22 (19-25); CD was excluded in 18 (21%), mild in 50 (59.5%), moderate in 15 (19%) and severe in 1. Mean MoCA score at follow-up was 21.9(± 4.69) and did not differ significantly from baseline (21.79 (± 4.61), p = 0.73). There was no difference in success rate, in-hospital complications, or death across CD categories. CONCLUSION: The clinical course of patients with mild or moderate CD is not different at 1 year after TAVI compared to those without cognitive dysfunction.

Creating an Effective Clinic Model for Post-COVID Mental Health Treatment

Background: The University of Colorado (UCH) Consultation-Liaison Psychiatry (CLP) service and Psychiatric Consultation for the Medically Complex clinic (PCMC) are developing a brain health outreach program for those hospitalized with COVID. Patients with COVID have increased risk of cognitive and psychiatric sequelae due to intrinsic viral properties, hyperinflammatory state, and increased disposition to ICU level care (Inoue, 2019;Cothran, 2020). Development of a post COVID brain health program has become paramount and UCH is not alone in creation of new clinic protocols to meet the needs of this population (Rovere Querini, 2020;O'Brien, 2020). Hospitals around the globe are developing new screeners to identify patients at higher risk of neuropsychiatric sequelae and refer them to appropriate resources. Methods: The program makes use of two arms: The first assesses those discharged from the hospital using a screener developed by the UCH post-COVID hospitalization program. The second screens patients currently admitted to the hospital with COVID using psychiatric and neurocognitive screeners. Both allow patients to be referred to PCMC for evaluation and treatment. Evaluation includes psychiatric interview and additional screeners including: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and PTSD Checklist for DSM-5 (PCL-5). Additional neuropsychiatric evaluation via Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and cognitive rehabilitation referral, are available. Clinic treatment includes pharmaceuticals, individual therapy referral, or referral to the PCMC COVID Survivorship Support Group. Results: To date, 100 patients have been screened in arm 1 (outpatient outreach) and arm 2 (inpatient outreach). In arm 2, about 54% of the population identifies as female, 46% as male, 61% identified as white, and 86% spoke English. Of those in arm 2 that agreed to full participation, 26% agreed to future check-ins and 6% were seen in the clinic. There was a difference in those who did and didn't fully participate based on ethnicity, language, and insurance status;though not of statistical significance. HADs scores demonstrated different trends based on these same demographic factors, though also not statistically significant. Discussion: By using this two-armed approach, the service has been able to more effectively outreach patients and refer them to appropriate care. Though data is not complete, referral needs seem to differ based on demographic data. Conclusions: As data continues to be collected, the clinic model is expanding to outreach high risk patients for neuropsychiatric sequelae. This will strengthen our existing system, with risk of reoccurrence of similar events, and inform a new standard of care for COVID survivors. 1. Cothran, T. P., Tam, J. W.;et.al. (2020). A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun, 88, 957-958. 2. Inoue, S., Nishida, O, et.al. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246. 3. O'Brien, H., Hurley, K., et.al. (2020). An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci, 1-8. 4. Rovere Querini, P., Ciceri, F., et.al. (2020). Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed, 91(9-s), 22-28.

Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19?

BACKGROUND: Cognitive complaints are one of the most frequent symptoms reported in post-acute sequelae of COVID-19 (PASC). The Montreal Cognitive Assessment (MoCA) has been used to estimate prevalence of cognitive impairment in many studies of PASC, and is commonly employed as a screening test in this population, however, its validity has not been established. OBJECTIVE: To determine the utility of the MoCA to screen for cognitive impairment in PASC. METHODS: Sixty participants underwent neuropsychological, psychiatric, and medical assessments, as well as the Montreal Cognitive Assessment, 6-8 months after acute COVID-19 infection. RESULTS: The overall sample had a mean score of 26.1 on the MoCA, with approximately one third screening below the cutoff score of 26, similar to the rate of extremely low NP test performance. MoCA score was inversely correlated with fatigue and depression measures and ethnic minority participants scored on average lower, despite similar education and estimated premorbid function. The MoCA had an accuracy of 63.3% at detecting any degree of diminished NP performance, and an accuracy of 73.3% at detecting extremely low NP performance. DISCUSSION/CONCLUSION: The MoCA may not be accurate for detecting neither mild nor more severe degrees of diminished NP test performance in PASC. Therefore, patients with persistent cognitive complaints in the setting of PASC who score in the normal range on the MoCA should be referred for formal NP assessment.

The post-acute sequelae of COVID-19 (PASC) experience in an outpatient neurology setting

Objective: To determine the frequency of post-acute COVID-19 sequelae (PASC) symptoms in an outpatient neurology setting. Background: Symptoms of fatigue, headaches, and memory impairment have been reported in patients with PASC. Design/Methods: This is an observational study of the PASC experience of 98 non-hospitalized COVID-positive patients in neurology outpatient clinics. Participants completed a survey regarding persistent symptoms, after acute infection. Scales of quality of life and cognition were obtained and included the Montreal Cognitive Assessment (MoCA) and Neuro-QOL (Anxiety, fatigue, depression). Results: Of 98 participants recruited, 68% of participants were seen in neurology clinic specifically for PASC while 31% were seen for non-COVID related complaints but had a prior positive COVID-19 test. Mean age was 50.5±15.1 and 65% were female. Median time post-acute infection was 9.0 (IQR 4.7-11.7/range 0.5 - 16.8) months. Of the 93 participants with symptoms after 6 weeks, the most frequent symptoms reported were fatigue (67%), headaches (49%), muscle aches (48%), word-finding difficulty (48%), difficulty sleeping (47%), shortness of breath (47%), and change in memory (46%). The most common pre-morbid conditions were anxiety/depression (32%), hypertension (26%), pulmonary disease (23%), and autoimmune (17%). BMI>25 was present in 68%. 41% had a prior neurological condition with migraines being the most common (18%). There was no statistically significant difference in reported symptoms, pre-morbid conditions, sex, and age between participants who presented with PASC versus other neurological complaints. Patients reporting persistent fatigue (n=64) had a mean Neuro-QOL fatigue score of 53.3±9.9. Normal mean MoCA scores were present in patients reporting word finding difficulty or memory change (19.3±2.4 points) and in participants with abnormal Neuro-QOL scores (19.4±2.1 points). Conclusions: Patients with PASC in a neurology outpatient clinic report persistent neurological, systemic symptoms that affect their quality of life on multiple validated measures. The MoCA test may not be able to detect subtle cognitive deficits in this population.