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Background: Neurocognitive dysfunction is common in long COVID and in people living with HIV (PWH). It is unknown whether PWH experience different disturbances in neurocognitive function following COVID-19 compared to HIVseronegative people. Method(s): The amfAR-Johns Hopkins University COVID Recovery Study is a prospective observational cohort study consisting of four groups: participants who had SARS-CoV-2 infection for the first time within 30 days prior to enrollment with HIV (PWH, arm 1) and without HIV (arm 2);participants with no history of SARS-CoV-2 infection with HIV (arm 3) and without HIV (arm 4). 93.5% of the cohort had received a COVID-19 vaccine prior to enrollment. Cognitive tests were administered at 1-and 4-months post symptom onset (arms 1-2) or post-enrollment (arms 3-4) in seven domains. Age standardized scores (all tests) and age-sex-and education-standardized scores (verbal fluency) were obtained. Standardized scores were compared using the Mann-Whitney U Test and the Kruskal-Wallis test. Result(s): PWH scored lower than HIV-seronegative participants at 1 and 4 months post-COVID on three tests: the Hopkins Verbal Learning Test-Revised (HVLT-R) learning (M1, p=0.011, M4, p=0.015), HVLT-R memory (M1, p=0.029, M4, p=0.007), and category-cued verbal fluency (VF;M1&4, p< 0.001). For the majority of timepoints, PWH who were post-COVID produced equivalent scores as PWH who never had COVID (p-levels > 0.05). Comparing post-COVID HIV-seronegative people to those who never had COVID, post-COVID participants scored lower than never-COVID participants on the Oral Trail Making Test part A (OTMT) test of processing speed at month 1 (p=0.033). Between month 1 and 4, HIV-seronegative people who were post-COVID showed improvements in HVLT-R Recognition (p=0.039), OTMT A (p=0.003), and OTMT B test of executive function (p=0.032). Conclusion(s): Neurocognitive scores in PWH were independent of COVID status, suggesting that higher frequencies of post-COVID neurocognitive dysfunction in PWH compared to HIV-seronegative people are due to HIV-associated factors more so than COVID. HIV-seronegative, post-COVID people demonstrate diminished recognition memory, processing speed, and executive function at 1 month post-COVID that improves by 4 months. Post-COVID neurocognitive dysfunction is present, if temporary, even in a highly vaccinated cohort of people.
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Introduction: The first year of the COVID-19 pandemic presented a series of stressors that could relate to psychological difficulties in children and adolescents. Executive functioning (EF) supports goal achievement and is associated with life success, and better outcomes following early life adversity. EF is also strongly related to processing speed, another predictor of life outcomes. Methods: This longitudinal study examined 149 youths' pre-pandemic EF and processing speed abilities as predictors of self-reported emotional, cognitive, and social experiences during the first year of the COVID-19 pandemic. EF and processing speed were measured with a total of 11 behavioral tasks. The COVID-era data was collected during two timepoints, during early (May-July 2020) and mid- (January-March of 2021) pandemic. Results: Better pre-pandemic EF skills and processing speed abilities predicted more mid-COVID-19 pandemic emotional and cognitive difficulties. On the other hand, better switching (a subcomponent of EF) and processing speed abilities predicted more mid-pandemic social interactions. EF and processing speed abilities did not relate to the well-being reports from the initial months of the pandemic. Our EF - but not processing speed - results were largely maintained when controlling for pre-pandemic mental health burden, socioeconomic status (SES), and gender. Discussion: Better cognitive abilities may have contributed to worse mid-pandemic functioning by supporting the meta-cognition needed for attending to the chaotic and ever-changing pandemic news and advice, leading to higher stress-induced worry and rumination. Our study highlights a potential downside of higher EF - often largely viewed as a protective factor - in youth.
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Introduction: Long-COVID is associated with restrictions in neuropsychological health e.g., depression, anxiety, or cognitive impairments leading to deficits in work ability. Rehabilitation could improve these symptoms but less is known about the benefits of rehabilitation in patients acquiring COVID-19 in the workplace, e.g., healthcare professionals. Aims and objectives: The current study investigates the outcomes of a disease-specific rehabilitation on neuropsychological health in patients after acute COVID-19 acquiring in the workplace. We assumed that neuropsychological health will be improved after rehabilitation. Method(s): Until now, 49 patients (female n=38, age: M=50.86 years) acquiring COVID-19 in the workplace were recruited within a longitudinal study. At the beginning (T1) and the end (T2) of an inpatient rehabilitation (duration: at least 3 weeks) in the German BG Hospital Bad Reichenhall the following measurements were implemented: Hospital Anxiety and Depression Scale (for depression and anxiety), and Digit Symbol Substitution Test (for processing speed). Paired T-tests were used for analysis. Result(s): At T2 patients showed significant improvements in depression (T1: M=7.98, T2: M=7.02;T(1,45)=2.277, p=0.028, d=0.336), anxiety (T1: M=7.00, T2: M=6.02;T(1,45)=2.268, p=0.028, d=0.330), and processing speed (T1: M=47.14, T2: M=52.57;T(1,44)=2.852, p=0.007, d=-0.430). Conclusion(s): The results indicated that rehabilitation in patients acquiring COVID-19 in the workplace has positive effects on neuropsychological health. For long-term results, measurements will be repeated 6 and 12 months after T1.
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Abstract Post-Acute Sequelae of COVID-19 (PASC) has been associated with cognitive impairment and complains in up to 90% of individuals after the infection by COVID 19. In this context, there is an urgent need to develop treatments for this disorder. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention that can modulate neuronal excitability and improve PASC neurocognitive symptoms. Here, we investigated the effects of this intervention in a case series of four patients with cognitive symptoms using the Assessment of PASC (A-PASC) inventory. The intervention consisted of 20-minute, 2mA, 20 daily sessions of bilateral prefrontal (anodal-left/cathodal-right) tDCS (1x1 Mini-CT, Soterix Medical, New York, NY) plus online cognitive training using the BrainHQ platform (Posit Science, San Francisco, Glenn Smith). Several neuropsychological domains were assessed at baseline and endpoint. After treatment, all participants described cognitive and emotional complaints decreasing. The neuropsychological assessment showed that the participants performed better for delayed and immediate recall in the verbal episodic memory task. They showed an improving trend in lexicon assessment, and in phonemic verbal fluency. The same was observed for the sustained attention task. Also, the participants showed a trend in becoming faster and more accurate in processing speed, and in executive function (inhibitory control, cognitive flexibility and time management). These are preliminary results from a pilot study that preceded an ongoing, double-blinded, randomized controlled trial comparing the effects of cognitive training combined with sham or active tDCS at University of Sao Paulo, Brazil. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: transcranial direct current stimulation, cognitive training, cognitive impairment, Post-Acute Sequelae of Sars-Cov2Copyright © 2023
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Separate lines of research have demonstrated relations between auditory temporal processing and language ability and between information processing speed and intelligence. Because these processes have rarely been studied in the same sample, it is unclear how auditory temporal processing and information processing speed may operate together and how they may relate to cognitive functions including language. The overarching aim of this dissertation was to integrate these lines of research to better understand whether auditory temporal processing has a unique relation with language, or whether it relates more broadly to language and other cognitive functions as a part of global information processing speed. Study 1 examined auditory temporal processing, information processing speed, language ability, and intelligence in 4-6 year olds (N=47). Results revealed that auditory temporal processing and information processing speed correlated with age and with each other, but previously identified correlations with language and intelligence were not supported. Results raised questions about the auditory temporal processing measure used, thus Study 2 involved a mixed methodological scoping review to disentangle behavioural measures and constructs of auditory temporal processing in the extant literature. The review identified five categories of tasks that reportedly measure six auditory temporal processing constructs. Study 3 was planned as a pilot of three, child-friendly auditory temporal processing tasks that were designed and programmed based on Study 3 results, using a sample of adults and investigating the same relations as Study 1. Data collection was interrupted by Covid-19, thus Study 3 was written as a pre-registration and Study 4 involved a feasibility assessment for measuring auditory temporal processing online. Results revealed that measuring auditory temporal processing online shows promise, but must first be tested to ensure accuracy, precision, and quality of stimuli in the specific context of the tasks being used due to the potential impact on millisecond level timing. Although the direction of this dissertation took a step back to disentangle questions outside of the original overall aim, the collective results return the field to a place where the original questions may be investigated with better clarity about important considerations that need to be made moving forward. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The purpose of this study is to investigate the impact of background sounds (rap music and rock music specifically) on the speed of an adult's ability to problem solve. These two popular genres of music within the adult population carry a negative relationship between rap and rock music on the listener in previous studies. For this study, participants were recruited from around the world via social media. There were no statistically significant findings in problem solving speed across all conditions (classical, rap, rock, background conversations, and silence), likely due to a small sample size as a result of Covid-19. Those who listened to rock music performed on average the fastest of the music genres. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Objective: The COVID-19 pandemic created unique challenges for neuropsychological assessment of DBS candidates due to physical distancing and safety requirements. Existing literature has demonstrated guidelines and feasibility of neuropsychological measures administered via teleconference, but none to our knowledge have assessed implementation, feasibility, clinical utility, and acceptance of home-to-home TeleNP in determining candidacy for DBS in Parkinson's disease (PD) patients. Background: PD is the second most common neurodegenerative disorder and DBS surgery offers significant improvement in motor symptoms and quality of life for medication refractory patients. Since neuropsychologists play an essential role in evaluating cognitive and behavioral changes that impact decisions on DBS surgical candidacy, adapting current practices is critical for continuity of care. Design/Methods: PD patients [n=72, M =63.3(8.76), 65.3% male, M =14.7(2.93), 50.7% Hispanic, 58.3% tested in English/41.7% in Spanish) underwent neuropsychological (global cognition, language, memory, attention, processing speed, visuospatial ability) and emotional assessments via home-to-home TeleNP between May 2020 and August 2021. Independent t-tests were conducted to assess TeleNP discriminability of cognitive and emotional function in surgical candidates. Results: To date, 66 candidates were approved for DBS (44 completed surgery, 17 are pending, 5 opted not to proceed), and 6 were not surgical candidates due to neurocognitive and/or severe psychiatric disorders. Surgical candidate mean neuropsychological scores were average across all domains, with normal to mild mood symptoms. The non-selected group differed by education but not age, and was significantly different (p≤.006) in overall cognition [MoCA t(70)=3.62], age edu working memory [WAIS-IV DS t(70)=3.15], phonemic fluency [COWAT FAS t(70)=2.85], verbal reasoning [WAIS-IV SI t(67)=3.38], perceptual reasoning [WAIS-IV MR t(70)=3.02], depression [BDI-2 t(68)=3.47], and anxiety [BAI t(70)=2.88]. Conclusions: TeleNP is a successful platform for assessing DBS surgical candidacy safely in English and Spanish speaking PD patients and offers potential for providing high quality screening for those with physical limitations, reduced access to transportation, or are living in remote areas.
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Introduction: As the use of CAR-T cell therapy grows, there is an increased need to understand its impact on the patient experience, especially symptom burden and cognitive function. While the immediate side-effects of CAR-T therapy have been reported, our study aims to describe the longitudinal impact of CAR-T therapy on patients' quality of life (QoL), including patient-reported cognitive function and performance-based cognition, which are not well understood. Methods: Patients with hematologic malignancies undergoing CAR-T therapy were prospectively recruited from two academic centers. The primary endpoint was feasibility of completing longitudinal PRO assessments and PBM of cognition. NIH PROMIS measures assessed physical, mental, cognitive, and social health. PROMIS measures use the t-score metric, where 50 is the average in the U.S. population and a 5 point (0.5 SD) change was considered clinically meaningful. The NIH Toolbox Cognition Battery measured 6 constructs of cognition, scored on the t-score metric (10 point = 1SD, change considered clinically meaningful). Exploratory analyses described change from baseline. PROMIS measures were completed at baseline, 7 and 14 days, 1, 3, 6, and 12 months (mo) after CAR-T. The Toolbox was assessed at baseline, 1 month, and 12 months. Due to COVID restrictions on in person research, the Toolbox could not be assessed for the first 13 patients. Results: From 8/2020 to 6/2021, 28 patients have been enrolled. Baseline, day 7, day 14, 1 mo, 3 mo, and 6 mo data were available in 27, 20, 21, 23, 15 (10 not yet reached), and 9 (16 not yet reached) patients, respectively. The mean age was 57 years (range 27-78);44% were female. Race distribution was: Caucasian 75%, Asian 8%, Hawaiian/Pacific Islander 4% and other race 8%;21% were Hispanic ethnicity. Patients received CAR-T for diagnoses of NHL (75%), MM (17%), and ALL (13%). CRS was seen in 86% (all grade 1-2), neurotoxicity (ICANS) in 34% (grade 1-2: N=5 and grade > 3: N=5). PROMIS questionnaires were completed in >70% of patients across all timepoints with current follow-up;thus it was feasible to collect these data at frequent intervals after CAR-T. Mean baseline PROMIS t-scores (N=27) were similar to the average US population in all domains (fatigue: 53, sleep: 52, pain: 52, anxiety: 53, depression: 49) except for decreased physical function (44) among patients (Fig 1a-b). Physical function, fatigue, and pain interference worsened during the first month but returned to baseline by month 3 (Fig 1a-b). PBM of cognition (NIH Toolbox) were assessed at baseline in 15 pts and 1 mo in 8 patients (4 incomplete, 3 not reached timepoint). The toolbox requires in-person administration and takes 35 minutes, but has been completed in 75% of evaluable patients. At baseline, the mean total composite score was 65 th percentile and t-score was 57;mean fluid composite score was 50 th percentile and t-score was 50;mean crystallized composite score was 69 th percentile and t-score was 58 (fluid composite score measures ability to reason, crystallized composite score measures accrual of knowledge over time, Weintraub et al Neurology 2013). Little change in scores was seen in language domains and some increase (not clinically significant) was seen in constructs on attention, executive function, and episodic memory. While not significant, a trend towards worsening working memory and processing speed and a trend towards worsening t-scores for all composite scores was seen (Figure 1c). 2 patients with neurotoxicity grade 3 and available baseline and 1-mo Toolboxes were noted to have decreases in all composite scores (clinically significant in 1). Patients did not self-report changes in cognitive function over 6 months (Fig 1d). Conclusion: This study reports early data from longitudinal neurocognitive assessments and PROs in patients undergoing CAR-T. It is feasible for patients undergoing CAR-T to complete PROMIS surveys (PROs) and NIH cognitive Toolboxes (performance-based test). Early and frequent PRO surveys captured initial worsening in hysical function, fatigue, and pain interference that returned to baseline by month 3. There was no change in patient-reported cognitive function over time, but using PBM cognition testing, we noted a trend towards worsening cognition in some domains. Continued patient accrual and longer follow up will allow assessment of degree and persistence of worsened PBM cognition associated with CAR-T. [Formula presented] Disclosures: Frank: Allogene Therapeutics: Research Funding;Kite-Gilead: Membership on an entity's Board of Directors or advisory committees;Adaptive Biotechnologies: Research Funding. Shah: Lily: Consultancy, Honoraria, Research Funding;Miltenyi Biotec: Consultancy, Honoraria, Research Funding;Epizyme: Consultancy;Legend: Consultancy;Kite: Consultancy;Incyte: Consultancy;Umoja: Consultancy. D'Souza: Imbrium, Pfizer, BMS: Membership on an entity's Board of Directors or advisory committees;Janssen, Prothena: Consultancy;Sanofi, Takeda, Teneobio, CAELUM, Prothena: Research Funding. Miklos: Pharmacyclics: Patents & Royalties;Kite, a Gilead Company, Amgen, Atara, Wugen, Celgene, Novartis, Juno-Celgene-Bristol Myers Squibb, Allogene, Precision Bioscience, Adicet, Pharmacyclics, Janssen, Takeda, Adaptive Biotechnologies and Miltenyi Biotechnologies: Consultancy;Pharmacyclics, Amgen, Kite, a Gilead Company, Novartis, Roche, Genentech, Becton Dickinson, Isoplexis, Miltenyi, Juno-Celgene-Bristol Myers Squibb, Allogene, Precision Biosciences, Adicet, Adaptive Biotechnologies: Research Funding;Adaptive Biotechnologies, Novartis, Juno/Celgene-BMS, Kite, a Gilead Company, Pharmacyclics-AbbVie, Janssen, Pharmacyclics, AlloGene, Precision Bioscience, Miltenyi Biotech, Adicet, Takeda: Membership on an entity's Board of Directors or advisory committees. Muffly: Pfizer, Amgen, Jazz, Medexus, Pfizer: Consultancy;Adaptive: Honoraria, Other: fees for non-CME/CE services:, Research Funding;Astellas, Jasper, Adaptive, Baxalta: Research Funding. Sidana: Janssen: Consultancy, Research Funding;Magenta Therapeutics: Consultancy, Research Funding;Allogene: Research Funding;BMS: Consultancy.
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Considering the mechanisms capable of causing brain alterations in COVID-19, we aimed to study the occurrence of cognitive abnormalities in the months following hospital discharge. We recruited 38 (aged 22-74 years; 27 males) patients hospitalized for complications of SARS-CoV-2 infection in nonintensive COVID units. Participants underwent neuropsychological testing about 5 months after hospital discharge. Of all patients, 42.1% had processing speed deficits, while 26.3% showed delayed verbal recall deficits. Twenty-one percent presented with deficits in both processing speed and verbal memory. Bivariate analysis revealed a positive correlation between the lowest arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2) (P/F) ratio during hospitalization and verbal memory consolidation performance (SRT-LTS score, r = 0.404, p = 0.027), as well as a positive correlation between SpO2 levels upon hospital arrival and delayed verbal recall performance (SRT-D score, rs = 0.373, p = 0.042). Acute respiratory distress syndrome (ARDS) during hospitalization was associated with worse verbal memory performance (ARDS vs. no ARDS: SRT-LTS mean score = 30.63 ± 13.33 vs. 44.50 ± 13.16, p = 0.007; SRT-D mean score = 5.95 ± 2.56 vs. 8.10 ± 2.62, p = 0.029). Cognitive abnormalities can frequently be found in COVID-19 patients 5 months after hospital discharge. Increased fatigability, deficits of concentration and memory, and overall decreased cognitive speed months after hospital discharge can interfere with work and daily activities.