Perceived stress, worries and changes in interpersonal relationships during the COVID-19 pandemic: Psychopathological and cognitive precursors in a 10-year youth cohort

Aims: to investigate if mental disorders and cognitive performance are associated with interpersonal behaviours and negative emotions among youth during the COVID-19 pandemic. Method(s): This work is part of the Brazilian High-Risk Cohort for Mental Conditions (BHRC), which included 6-12 years-old children at baseline (Year 2010) who participated in an online COVID-19 wave (N = 1.144). Outcomes were factor socres from specifc sections of the international Coronavirus Health and Impact Survey (relationship changes, stress, and concerns related to COVID-19). A structured interview (DAWBA, DSM-IV) assessed externalizing and internalizing disorders. Cognitive predictors were IQ and executive function assessed at baseline. We used Generalized Linear Models adjusting for sex and socioeconomic variables. First, higher IQ (B = 0.0032;t = 2.714;p = .006) and any internalizing disorder prior to the pandemic (B = 0.0902;t = 2.228;p = .026) were associated with higher perceived stress during the pandemic. Second, any externalizing disorder (B = -0.1449;t = -2.066;p = .039) was linked with lower levels of COVID-19-related worries, whilst higher performance in executive function tasks was associated with higher levels (B = 0.1803;t = 4.796;p = .001). Third, higher IQ was linked with negative changes in interpersonal relationships (B = -0.0007;t = -3.371;p = .0007). Conclusion(s): This study showed that lifetime externalizing and internalizing disorders, in addition to cognitive variables at lifetime externalizing and internalizing disorders, in addition to cognitive variables at an early age, were associated with distinct mental health outcomes during the COVID-19 pandemic.

Computerized Cognitive Testing in Long COVID Patients With Prolonged Symptoms of Brain Fog and Cognitive Impairment

Purpose: To identify cognitive impairments in patients (pts) with long COVID using the Cambridge Brain Sciences (CBS) computerized cognitive test (CCT) commonly used to evaluate cognitive function after concussions and traumatic brain injuries. Method(s): Retrospective review from May 2021-Sept 2022 of 16 (4 male, 12 female) patients with long COVID, ages 13- 66 (avg 46), with average of 10 months from COVID infection to time of evaluation. Cognitive (cog) performance and concussion profile symptom scores were assessed with CBS CCT and the Concussion Clinical Profiles screening tool (CP screen) respectively. Result(s): The total CP symptom score average was 34/89 (ranging 7-68) in the cohort. The predominant profile was cog fatigue scoring (1.8/3) on average. CBS CCT tested cog impairment (CI) and was divided into 5 categories (0-4): no CI, borderline (scores between the 21st-30th percentile), mild (1 test < / = 20th percentile), moderate (2-3 tests < / = 20th percentile), and severe CI (>3 tests,/520th percentile). Data showed 2/16 (13%) patients had no CI, 5/16 (31%) had borderline CI, 5/16 (31%) had mild CI, 3/16 (19%) had moderate CI, and 1/16 (6%) pts had severe CI. Although not significant, there was a positive correlation between CI and cog profile score (P = 0.3149) when performing a linear regression test. Deficits were most common in the CBS CTT composites of grammatical reasoning/verbal processing and attention, with 4/16 patients scoring < 20th percentile for each test. The lowest average percentile scores for the cohort were in visuospatial processing and verbal short-term memory. Conclusion(s): Most long COVID patients assessed with CCT demonstrated signs of CI, in particular in verbal processing and memory, followed by visual processing. In addition to the CCT results illustrating CI, the top CP profile of cognitive fatigue in this cohort suggests that the brain fog experienced by long COVID patients may be quantified. Significance: CCT may be a useful tool in assessing and quantifying those with Long COVID with chronic symptoms of cognitive fog, fatigue, or impairment. Targeted interventions aimed at specific deficits can aid in treatment and recovery.

Management of patients with cognitive impairment.

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly - Alzheimer's disease (AD) - is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

Abstracts From the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2022 Scientific Sessions

The proceedings contain 385 papers. The topics discussed include: racial and ethnic differences in the population burden of dementia attributable to modifiable risk factors in the United States;higher visit-to-visit variability in fasting glucose and HbA1c is associated with decline in global cognitive performance: the Multi-Ethnic Study of Atherosclerosis (MESA);prevalence of stroke symptoms among Hispanic/Latino adults in the Hispanic community health study/study of Latinos (HCHS/SOL);educational attainment and dementia risk: mediation by vascular risk factors at mid-life in the atherosclerosis risk in communities (ARIC) study;a healthy plant-based diet was associated with slower cognitive decline in African Americans: a biracial community-based cohort of older adults;outcome preferences related to cardiovascular preventive therapies in older adults: an online survey;subclinical myocardial injury, coagulopathy, and inflammation in Covid-19: a meta-analysis;COVID-19 and type II NSTEMI: a comprehensive overview;association of antecedent statin use with outcomes of people with Covid-19 admitted at northwestern medicine health system;and social determinants of health and ambulatory outcomes among Covid-19 positive patients: differences by race/ethnicity.

Management of patients with cognitive impairment.

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly - Alzheimer's disease (AD) - is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

Mental and Physical Performance of Adult during the COVID-19 Pandemic and Use of Dietary Supplements

Background: Life during the COVID-19 pandemic was miserable, most of the people were in a panic situation either because of being affected by COVID-19 or losing their near and dear ones. Majority of Indian population was in the trauma condition impacting physical and mental health directly or indirectly either due to the infection or repeated lockdowns. Aim(s): The present study was carried out to gain knowledge of people's physical and mental health such as anxiety, depression, and stress during the period of the pandemic in the year 2021. Material(s) and Method(s): The standard questionnaires were used to conduct the online survey using google form. The questionnaire contains five sections and collects the information on anxiety, stress, depression, and physical activities. The survey started on May 23, 2021, and ended on June 2, 2021 by circulating the link through emails, WhatsApp, and messages. Result(s): A total of 291 people participated in this survey process and all responses were analyzed, out of which 165 were men and 126 were women. It was calculated that 59.4% of men and 40.6% of women were affected by COVID-19. Total 49.5% of people affected by COVID-19 were in favor of improvement in physical and mental performance while taking dietary supplements. Whereas 19.8% denied the statement and 28.7% of people saw slight changes in their health status. Conclusion(s): During the pandemic people were mostly affected by anxiety, depression, stress, and physical health and to cope with these situations dietary supplements surely be the utilitarian for the society. Through this study, it was found that if a person includes both exercise and nutraceutical products in their lifestyle, there will be a chance of living a sustainable and healthy life. Copyright © 2022 International Journal of Nutrition, Pharmacology, Neurological Diseases Published by Wolters Kluwer - Medknow.

Metacognition in older African American adults during the COVID-19 pandemic

Background: There is a critical need to identify older adults in the earliest stages of cognitive decline for targeted dementia reduction interventions. Subjective memory concerns often drive older adults to seek objective memory assessments. However, there is often poor agreement between subjective complaints and objective measures. Previous research suggests that self-appraised memory decline may be more sensitive to mild cognitive impairment than objective measures, but factors influencing the relationship between self-perceived and actual functioning are unclear. Subjective memory appraisal may be susceptible to negative affective perceptions such as anxiety. Anxiety has increased substantially during the pandemic, suggesting the heightened potential for it to distort subjective perceptions, thereby increasing demands for cognitive assessments. This study investigated whether the discrepancy between subjective cognitive concerns and objective cognitive performance is related to anxiety in a sample of older African American adults. Method(s): Telephone screenings were administered to 206 older African Americans (aged 64-94 years) during the first year of the pandemic as part of a more extensive study. Demographic data, objective memory (Telephone Interview for Cognitive Status [TICS]), subjective memory (Cognitive Change Questionnaire [CCQ]), and anxiety (Generalized Anxiety Disorder-7 [GAD-7]) were measured, along with survey questions about affective and stress responses to COVID-19 experiences. Result(s): Objective TICS scores were predictive of subjective CCQ executive function scores (F(1, 197) = 4.37, p =.038, R2 =.022). Discrepancy scores were calculated as the standardized residual variance between objective and subjective measures. Discrepancy scores were correlated with anxiety (r =.396, p<.001), indicating that higher anxiety was related to an overestimation of cognitive difficulty relative to the level of objective cognitive resources. Conclusion(s): Objective and subjective measures of cognition are related. However, discrepancies exist between objectively-measured and self-perceived cognition. Elevation in anxiety level is associated with greater overestimation of cognitive difficulties relative to one's objective level of cognition. As pandemic-related stressors have worsened anxiety for some, individuals with higher anxiety may also have depreciated their self-appraisal of cognitive abilities in the present climate. Clinicians should consider anxiety as a possible contributing factor when assessing subjective cognitive difficulties. Copyright © 2022 the Alzheimer's Association.

Dynamics of emotional disorders in students of medical university in the context of the covid-19 pandemic

Introduction: The covid-19 pandemic is having a significant impact on the mental health of the entire population. Objective(s): To determine the dynamics of emotional disorders in medical students in the context of the covid-19 pandemic. Method(s): Methods of research. An online survey of medical university students was conducted during the covid-19 pandemic. The Beck scale was used. Result(s): Results and its discussion. According to a dynamic study of emotional disorders in medical students, which was held during 12 months of covid-19 pandemic, emotional disturbance in the form of depressive manifestations associated with the covid-19 pandemic did not reduced. In addition, the results of the study indicated a change in the structure of depressive manifestations in the surveyed in favor of milder depressive manifestations (27.2%;24.0%) and a decrease in the prevalence of moderate and severe manifestations of depression (3.0%;5.3%). Conclusion(s): The long-covid pandemic has a negative effect on the mental health of medical students and lead to emotional disturbances in the form of depressive manifestations of varying severity. The compensatory possibilities of mental activity proceed unilaterally with a change in the structure of emotional disorders;adaptation to a stress factor is not formed.

BLENDED LEARNING MODALITIES: EXAMINING THE STUDENTS’ COGNITIVE PERFORMANCE USING THE DIGITAL AND PRINTED MODULES

Pandemic has not only brought significant changes in the world’s economy. The educational sector has also made abrupt adjustments just to cater to the needs of learners. Among the solution that wasrealized in the Philippines was the implementation of the blended learning modality. Public schools prepared digital and printed copy of modules which will serve as the self-learning kit of the students when the face-to-face teaching was not possible due to the COVID 19 pandemic. Aligned to this context, the present study aimed to gauge the cognitive performance of the students and to know the extent of the usage of digital and printed modules. Utilizing a quantitative approach, the data revealed that the Senior High school students showed similar extent of using the digital and printed module during the implementation of the blended learning modalities. Both were extensively utilized by the respondents. This explains that student’s agreement on the usage of digital copy of the module may be because of their ability on the digital technologies, the availability of gadgets and the internet connectivity knowing for a fact that the research locale is a highly urbanized city. Therefore, the study recommends t hat teachers may consi der the preference of st udent s whether to use di gi tal, pri nted modul e or whatever modal i t i es that are appropri ate to the l earni ng scheme of the st udents.

PSYCHOSOMATIC INTERVENTIONS FOR FUNCTIONAL POST-COVID SYNDROMES: OPEN-LABEL PLACEBO AND PACED BREATHING AS PATIENT-TAILORED INTERVENTIONS

Background: Up to 80% of patients suffering from persistent symptoms more than six months after a COVID-19 infection complain about a variety of psychosomatic symptoms with no organ cause. Most patients suffer from chronic fatigue, pain, depression or difficulty concentrating. Experimental studies showed that these symptoms could be significantly improved after an open administration of placebos (“open-label placebo”) or with heart rate variability (HRV) biofeedback such as paced breathing. However, we insufficiently understand which patients benefit from which treatment. Methods: Patients (m/f) without organic causes for the complaints are randomised to three groups: an open-label placebo intervention (OLP), a paced breathing training (PBT) or no additional treatment (TAU). To detect a mean effect using a 2x3 ANOVA, N=90 patients will be included, and predictor analyses are performed. The OLP group takes 2 placebos/day and receives the information that placebos can significantly improve symptoms, e.g. via the activation of “self-healing powers”. The PBT group receives a standardized training to breath at 6 breaths/min for 10 min/day. At inclusion (T0) and after four (T1) and eight weeks (T2), treatment expectations, fatigue (FSMC), somatoform complaints, depressiveness, anxiety (PHQ), general health (SF-36) and quality of life, as well as cognitive performance using Corsi Span and Colour Stroop tests, will be assessed by questionnaires and tests, and an ECG will be recorded. Results: Preliminary results point to effective reductions of fatigue and other symptoms for both interventions compared to TAU, dependent on patients' individual factors such as treatment expectations, symptom severity during Covid-19 infection and at inclusion. HRV data will be analysed at the end of the study. Preliminary results will be presented at the conference. Conclusion: Patients with functional post-COVID syndromes can benefit from psychosomatic interventions aiming to improve treatment expectations and heart rate variability, depending on individual patients' factors. Patient-tailored interventions should be further investigated.

RAFAEL: A useful chatbot to interact with children about post-covid (long covid) condition

Post-Covid condition (or long covid) describes the persistence of symp-toms several months to years after SARS-CoV-2 infection. It has been in-creasingly described in children as well, particularly in preteens and teen-agers. Most commonly reported symptoms include fatigue, difficulty con-centrating, sleeping disorders, shortness of breath, and mood disorders. Treatment of these symptoms is limited and consists mostly of adaptation of physical and mental activities, reconditioning and motivational sup-port. Improving information and awareness of this condition are priorities to properly evaluate and treat these children. The Department of General Pediatrics in Geneva has set up a specific consultation for children and adolescents in spring 2021. In addition, in collaboration with the Depart-ment of Community Medicine and Primary Care and Emergency Medicine, we developed an academic digital citizen platform (RAFAEL), which com-bines an information site, a chatbot, and webinars/workshops for both children and adults. We report here our experience with the use of the pediatric chatbot which was launched on February 1st 2022. The chatbot is a conversational agent that can answer questions in real-time and reorient people to a special-ist/advisor if needed. Chatbot technology is useful in providing verified information and prompting communication and interaction with a large number of people simultaneously and can be adapted to all age groups. It is particularly appealing to teenagers who are very familiar with the con-cept of chatbot technology and may find this way to communicate more appealing than regular website information or traditional literature. We will report the initial frequently asked questions and their evolution over time within this chatbot. We will also report the number of users of the pediatric chatbot, the overall and individual match rates, and users' satis-faction. A platform, such as RAFAEL, could become a new way to interact with young patients regarding non urgent subjects, prevention, chronic dis-eases, as well as a way to use their regular feed-back to be as close as possible to the patients' needs.

The impact of social isolation during covid-19 on cognition in older adults

Background: A correlation between social isolation and poorer cognitive function in later life has been increasingly implied in literature. Research indicates that maintaining a socially active lifestyle can enhance cognitive reserve and benefit cognitive function. Whereas social exclusion has been significantly associated with higher risks of cognitive impairment (Evans, et al., 2019). Recent studies reviewed the consequences of restrictive living conditions during COVID-19, finding poorer cognitive performance (Ingram, et al., 2021).However, few services have investigated this. This study intended to explore the impact of social isolation on cognitive function of hospitalised older adults. Methods: Quantitative measures were used. A retrospective review of cognitive results of individuals open to occupational therapy in an acute Care of the Older Person's service in May 2018 (n=23) were compared to cognitive results of individuals open to occupational therapy in the same acute Care of the Older Person's service in May 2021 (n=62). Results: For the purpose of this study, cognitive results were compared by means of assessment results which indicated a mild, moderate or significant cognitive impairment. Of the patients seen in May 2021 (n=62), 9.68% (n=6) had a mild cognitive impairment, 25.81% (n=16) had a moderate cognitive impairment and 32.26% (n=20) presented with a significant cognitive impairment. Comparatively in May 2018 (n=23), 30.43% (n=7) had a mild cognitive impairment, 43.38% (n=10) had a moderate cognitive impairment and just 4.35% (n=1) presented with a significant cognitive impairment. Conclusion: A substantial increase in the number of inpatients presenting with a significant cognitive impairment in an acute Care of the Older Person's service was found between May 2018 (4.35%) and May 2021 (32.26%). This suggests that COVID-19 had a severe impact on cognitive functioning of older adults and implies that this cohort are at a high risk of cognitive decline caused by social isolation. These findings are preliminary and further research is recommended.